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Hydroxyurea Use for Sickle Cell Disease Among Medicaid-Enrolled Children.
Pediatrics. 2019 07; 144(1)Ped

Abstract

BACKGROUND

Recent publications should have resulted in increased hydroxyurea usage in children with sickle cell disease (SCD). We hypothesized that hydroxyurea use in children with SCD increased over time and was associated with decreased acute care visits.

METHODS

This was a secondary analysis of the Truven Health Analytics-IBM Watson Health MarketScan Medicaid database from 2009 to 2015. The multistate, population-based cohort included children 1 to 19 years old with an International Classification of Diseases, Ninth or 10th Revision diagnosis of SCD between 2009 and 2015. Changes in hydroxyurea were measured across study years. The primary outcome was the receipt of hydroxyurea, identified through filled prescription claims. Acute care visits (emergency department visits and hospitalizations) were extracted from billing data.

RESULTS

A mean of 5138 children each year were included. Hydroxyurea use increased from 14.3% in 2009 to 28.2% in 2015 (P < .001). During the study period, the acute-care-visit rate decreased from 1.20 acute care visits per person-year in 2009 to 1.04 acute care visits per person-year in 2015 (P < .001); however, the drop in acute care visits was exclusively in the youngest and oldest age groups and was not seen when only children enrolled continuously from 2009 to 2015 were analyzed.

CONCLUSIONS

There was a significant increase in hydroxyurea use in children with SCD between 2009 and 2015. However, in 2015, only ∼1 in 4 children with SCD received hydroxyurea at least once. Increases in hydroxyurea were not associated with consistently decreased acute care visits in this population-based study of children insured by Medicaid.

Authors+Show Affiliations

Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; dbrousse@mcw.edu.Children's Hospital Association, Lenexa, Kansas.Children's Hospital Association, Lenexa, Kansas.Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center and College of Medicine, University of Cincinnati, Cincinnati, Ohio.Section of Academic General Pediatrics, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina; and.Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta and Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31227564

Citation

Brousseau, David C., et al. "Hydroxyurea Use for Sickle Cell Disease Among Medicaid-Enrolled Children." Pediatrics, vol. 144, no. 1, 2019.
Brousseau DC, Richardson T, Hall M, et al. Hydroxyurea Use for Sickle Cell Disease Among Medicaid-Enrolled Children. Pediatrics. 2019;144(1).
Brousseau, D. C., Richardson, T., Hall, M., Ellison, A. M., Shah, S. S., Raphael, J. L., Bundy, D. G., & Arnold, S. (2019). Hydroxyurea Use for Sickle Cell Disease Among Medicaid-Enrolled Children. Pediatrics, 144(1). https://doi.org/10.1542/peds.2018-3285
Brousseau DC, et al. Hydroxyurea Use for Sickle Cell Disease Among Medicaid-Enrolled Children. Pediatrics. 2019;144(1) PubMed PMID: 31227564.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hydroxyurea Use for Sickle Cell Disease Among Medicaid-Enrolled Children. AU - Brousseau,David C, AU - Richardson,Troy, AU - Hall,Matt, AU - Ellison,Angela M, AU - Shah,Samir S, AU - Raphael,Jean L, AU - Bundy,David G, AU - Arnold,Staci, PY - 2019/03/22/accepted PY - 2019/6/23/pubmed PY - 2019/12/25/medline PY - 2019/6/23/entrez JF - Pediatrics JO - Pediatrics VL - 144 IS - 1 N2 - BACKGROUND: Recent publications should have resulted in increased hydroxyurea usage in children with sickle cell disease (SCD). We hypothesized that hydroxyurea use in children with SCD increased over time and was associated with decreased acute care visits. METHODS: This was a secondary analysis of the Truven Health Analytics-IBM Watson Health MarketScan Medicaid database from 2009 to 2015. The multistate, population-based cohort included children 1 to 19 years old with an International Classification of Diseases, Ninth or 10th Revision diagnosis of SCD between 2009 and 2015. Changes in hydroxyurea were measured across study years. The primary outcome was the receipt of hydroxyurea, identified through filled prescription claims. Acute care visits (emergency department visits and hospitalizations) were extracted from billing data. RESULTS: A mean of 5138 children each year were included. Hydroxyurea use increased from 14.3% in 2009 to 28.2% in 2015 (P < .001). During the study period, the acute-care-visit rate decreased from 1.20 acute care visits per person-year in 2009 to 1.04 acute care visits per person-year in 2015 (P < .001); however, the drop in acute care visits was exclusively in the youngest and oldest age groups and was not seen when only children enrolled continuously from 2009 to 2015 were analyzed. CONCLUSIONS: There was a significant increase in hydroxyurea use in children with SCD between 2009 and 2015. However, in 2015, only ∼1 in 4 children with SCD received hydroxyurea at least once. Increases in hydroxyurea were not associated with consistently decreased acute care visits in this population-based study of children insured by Medicaid. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/31227564/Hydroxyurea_Use_for_Sickle_Cell_Disease_Among_Medicaid_Enrolled_Children_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&amp;pmid=31227564 DB - PRIME DP - Unbound Medicine ER -