Hydroxyurea adherence and associated outcomes among Medicaid enrollees with sickle cell disease

American Journal of Hematology - Tập 86 Số 3 - Trang 273-277 - 2011
Sean D. Candrilli1,2,3, Sarah H. O’Brien4,3, Russell E. Ware5, Milap C. Nahata6, Eric E. Seiber7, Rajesh Balkrishnan8,9
1Department of Pharmacy Administration and Policy, College of Pharmacy, The Ohio State University, Columbus, Ohio
2RTI Health Solutions, Research Triangle Park, North Carolina
3S.D.C. and S.H.O. contributed equally to this work.
4Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
5Department of Hematology, St. Jude Children’s Research Hospital, Memphis, Tennessee.
6Division of Pharmacy Practice and Administration, College of Pharmacy, The Ohio State University, Columbus, Ohio
7Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio
8Department of Clinical, Social and Administrative Pharmacy, School of Pharmacy, The University of Michigan, Ann Arbor, Michigan
9Department of Health Policy and Management, School of Public Health, The University of Michigan, Ann Arbor, Michigan

Tóm tắt

AbstractWhile 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. Am. J. Hematol. 2011. © 2010 Wiley‐Liss, Inc.

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Thông tin
Thông tin xuất bản

American Journal of Hematology

Tập 86 Số 3

273-277

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