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Hydroxyurea Use for Sickle Cell Disease Among Medicaid-Enrolled Children

David C Brousseau1, Troy Richardson2, Matt Hall2

  • 1Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; dbrousse@mcw.edu.

Pediatrics
|June 23, 2019
PubMed

Insights

Hydroxyurea use in children with sickle cell disease (SCD) significantly increased from 2009 to 2015. However, this rise in hydroxyurea treatment did not consistently decrease acute care visits for these children.

Area of Science:

  • Pediatric Hematology
  • Public Health
  • Pharmacological Interventions

Background:

  • Sickle cell disease (SCD) is a genetic blood disorder affecting millions globally.
  • Hydroxyurea is a medication shown to improve outcomes in SCD patients.
  • Recent trends suggest increased hydroxyurea use in pediatric SCD populations.

Purpose of the Study:

  • To evaluate the trend of hydroxyurea usage in children with SCD.
  • To determine if increased hydroxyurea use correlates with a reduction in acute care visits.
  • To analyze changes in acute care utilization among pediatric SCD patients over time.

Main Methods:

  • Secondary analysis of the Truven Health MarketScan Medicaid database (2009-2015).
  • Inclusion of children aged 1-19 with SCD diagnoses.
  • Assessment of hydroxyurea prescription claims and acute care visits (ED visits, hospitalizations).

Main Results:

  • Hydroxyurea use in children with SCD rose from 14.3% in 2009 to 28.2% in 2015 (P < .001).
  • Overall acute care visits per person-year decreased from 1.20 to 1.04 (P < .001).
  • The reduction in acute care visits was limited to the youngest and oldest age groups and not observed in continuously enrolled children.

Conclusions:

  • Hydroxyurea use significantly increased in children with SCD between 2009 and 2015.
  • Despite increased use, only about 25% of children with SCD received hydroxyurea in 2015.
  • Increased hydroxyurea prescription rates were not consistently associated with decreased acute care visits in this Medicaid-insured pediatric population.
Abstract

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