Faculty Collaboration Database

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

Date

06/23/2019

Pubmed ID

31227564

DOI

10.1542/peds.2018-3285

Scopus ID

2-s2.0-85068930487 (requires institutional sign-in at Scopus site)   31 Citations

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.

Author List

Brousseau DC, Richardson T, Hall M, Ellison AM, Shah SS, Raphael JL, Bundy DG, Arnold S

MESH terms used to index this publication - Major topics in bold

Acute Disease
Adolescent
Anemia, Sickle Cell
Antisickling Agents
Child
Child, Preschool
Cross-Sectional Studies
Drug Utilization
Emergency Service, Hospital
Female
Guideline Adherence
Hospitalization
Humans
Hydroxyurea
Infant
Male
Medicaid
Practice Guidelines as Topic
Practice Patterns, Physicians'
United States
Young Adult