Use of medications and services for the management of sickle cell disease

Shukla, Nidhi, M.S. in Pharmaceutical Sciences
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Sickle cell disease (SCD) is an inherited chronic disease with recurrent complications, high health care utilization and excessive costs. Preventative therapies, such as hydroxyurea, are known to prevent or reduce the frequency of SCD complications. The purpose of this study was to determine medication and healthcare services utilization for the management of SCD, in terms of index and subsequent therapies and services. This thesis also examined whether there were differences SCD-related prescription and healthcare utilization among patients of different age groups. Texas Medicaid prescription and medical claims from September 1, 2011 to August 31, 2016 were retrospectively analyzed. Patients aged 2-63 years with a primary diagnosis of SCD (ICD-9: 282.6x, ICD-10: D57.1) and receiving one or more SCD-related medications (hydroxyurea, opioid or non-opioid analgesics) were included. The primary outcomes were type of SCD index drug, adherence to hydroxyurea, days’ supply of opioid and non-opioid analgesics, utilization of SCD-related emergency department, inpatient and outpatient visits, and type of SCD index and subsequent healthcare services. A total of 2,339 patients were included in the study. For the index drug, the majority of the patients were prescribed opioid analgesics (45.7%), followed by non-opioid analgesics (36.6%), and only 6.5 percent were prescribed hydroxyurea. Only 20.7 percent had a hydroxyurea medication possession ratio (MPR) ≥ 80%, with highest mean adherence among children. Days’ supply of opioid and non-opioid analgesics was highest in older adults of age group 41-63. Healthcare service utilization was relatively high (compared to the general population) among age groups 2-12, 18-25 and 26-40. Slightly over one-third of the population (N=801; 34.3%) had either an index ED visit (74.7%) or ≥1 hospitalization (25.3%). In conclusion, patients with SCD enrolled in Texas Medicaid have low utilization of and adherence to hydroxyurea. Interventions to increase its adoption and adherence could benefit patients by helping them better managing their SCD complications. Opioid use is prevalent among all patients with SCD, and generally, opioid use increased with increasing age groups. Patients with SCD also have a high use of healthcare services such as emergency department, inpatient and outpatient visits, especially among adolescents and young adults. Further research is needed to determine how to better manage patients with SCD, particularly adolescents and young adults who may be transitioning from pediatric to adult care