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

Abstract

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 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.