Candrilli SD, O'Brien S, Ware RE, Balkrishnan R. Hydroxyurea adherence and associated outcomes in medicaid enrollees with sickle cell disease. Poster presented at the 51st American Society of Hematology Annual Meeting and Exposition; November 20, 2009. [abstract] Am J Hematol. 2011 Feb; 86(3):273-7.

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. Am. J. Hematol. 2011.

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