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Hydroxyurea adherence and associated outcomes among Medicaid enrollees with sickle cell disease.
Am J Hematol. 2011 Mar; 86(3):273-7.AJ

Abstract

While laboratory and clinical benefits of hydroxyurea for patients with sickle cell disease (SCD) are well-established, few data describe the extent and implications of non-adherence. We sought to assess adherence to hydroxyurea among patients with SCD and investigate associations between adherence and clinical and economic outcomes. Insurance claims of North Carolina Medicaid enrollees (6/2000-8/2008) with SCD were analyzed. Inclusion criteria included age < 65 years, continuous Medicaid enrollment ≥ 12 months before and following hydroxyurea initiation, and ≥ 2 hydroxyurea prescriptions. Three hundred twelve patients, mean age 21 (± 12.2) years, met inclusion criteria and 35% were adherent, defined as a medication possession ration (MPR) ≥ 0.80; mean MPR was 0.60. In the 12 months following hydroxyurea initiation, adherence was associated with reduced risk of SCD-related hospitalization (hazard ratio [HR] = 0.65, p = .0351), all-cause and SCD-related emergency department visit (HR = 0.72, p = .0388; HR = 0.58, p =.0079, respectively), and vaso-occlusive event (HR = 0.66, p = .0130). Adherence was associated with reductions in health care costs such as all-cause and SCD-related inpatient (-$5,286, p < .0001; -$4,403, p < .0001, respectively), ancillary care (-$1,336, p < .0001; -$836, p < .0001, respectively), vaso-occlusive event-related (-$5,793, p < .0001), and total costs (-$6,529, p < .0001; -$5,329, p <.0001, respectively). Adherence to hydroxyurea among SCD patients appears suboptimal and better adherence is associated with improved clinical and economic outcomes.

Authors+Show Affiliations

RTI Health Solutions, Research Triangle Park, North Carolina, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21328441

Citation

Candrilli, Sean D., et al. "Hydroxyurea Adherence and Associated Outcomes Among Medicaid Enrollees With Sickle Cell Disease." American Journal of Hematology, vol. 86, no. 3, 2011, pp. 273-7.
Candrilli SD, O'Brien SH, Ware RE, et al. Hydroxyurea adherence and associated outcomes among Medicaid enrollees with sickle cell disease. Am J Hematol. 2011;86(3):273-7.
Candrilli, S. D., O'Brien, S. H., Ware, R. E., Nahata, M. C., Seiber, E. E., & Balkrishnan, R. (2011). Hydroxyurea adherence and associated outcomes among Medicaid enrollees with sickle cell disease. American Journal of Hematology, 86(3), 273-7. https://doi.org/10.1002/ajh.21968
Candrilli SD, et al. Hydroxyurea Adherence and Associated Outcomes Among Medicaid Enrollees With Sickle Cell Disease. Am J Hematol. 2011;86(3):273-7. PubMed PMID: 21328441.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hydroxyurea adherence and associated outcomes among Medicaid enrollees with sickle cell disease. AU - Candrilli,Sean D, AU - O'Brien,Sarah H, AU - Ware,Russell E, AU - Nahata,Milap C, AU - Seiber,Eric E, AU - Balkrishnan,Rajesh, Y1 - 2011/02/15/ PY - 2010/12/09/received PY - 2010/12/13/accepted PY - 2011/2/18/entrez PY - 2011/2/18/pubmed PY - 2011/5/7/medline SP - 273 EP - 7 JF - American journal of hematology JO - Am J Hematol VL - 86 IS - 3 N2 - While laboratory and clinical benefits of hydroxyurea for patients with sickle cell disease (SCD) are well-established, few data describe the extent and implications of non-adherence. We sought to assess adherence to hydroxyurea among patients with SCD and investigate associations between adherence and clinical and economic outcomes. Insurance claims of North Carolina Medicaid enrollees (6/2000-8/2008) with SCD were analyzed. Inclusion criteria included age < 65 years, continuous Medicaid enrollment ≥ 12 months before and following hydroxyurea initiation, and ≥ 2 hydroxyurea prescriptions. Three hundred twelve patients, mean age 21 (± 12.2) years, met inclusion criteria and 35% were adherent, defined as a medication possession ration (MPR) ≥ 0.80; mean MPR was 0.60. In the 12 months following hydroxyurea initiation, adherence was associated with reduced risk of SCD-related hospitalization (hazard ratio [HR] = 0.65, p = .0351), all-cause and SCD-related emergency department visit (HR = 0.72, p = .0388; HR = 0.58, p =.0079, respectively), and vaso-occlusive event (HR = 0.66, p = .0130). Adherence was associated with reductions in health care costs such as all-cause and SCD-related inpatient (-$5,286, p < .0001; -$4,403, p < .0001, respectively), ancillary care (-$1,336, p < .0001; -$836, p < .0001, respectively), vaso-occlusive event-related (-$5,793, p < .0001), and total costs (-$6,529, p < .0001; -$5,329, p <.0001, respectively). Adherence to hydroxyurea among SCD patients appears suboptimal and better adherence is associated with improved clinical and economic outcomes. SN - 1096-8652 UR - https://www.unboundmedicine.com/medline/citation/21328441/Hydroxyurea_adherence_and_associated_outcomes_among_Medicaid_enrollees_with_sickle_cell_disease_ L2 - https://doi.org/10.1002/ajh.21968 DB - PRIME DP - Unbound Medicine ER -