Cost-effectiveness of hydroxyurea in reducing the frequency of pain episodes and hospitalization in pediatric sickle cell disease

Am J Hematol. 2010 Oct;85(10):795-7. doi: 10.1002/ajh.21772.

Abstract

In a cohort of children with sickle cell disease (SCD) and vaso-occlusive pain visits served through South Carolina's Medicaid system over a 6-year period (N 5 523), we compared the number of vaso-occlusive pain or acute chest syndrome (ACS)/pneumonia episodes, and outpatient or acute service costs in those treated or not treated with hydroxyurea (HU). HU may be an underused intervention for SCD in this practice setting, for a variety of reasons. Treatment with HU varied greatly, appears to have been administered to more severely ill children, but was associated with a reduction in vaso-occlusive pain episodes, hospitalizations,and total costs of care within the HU cohort during a 2-3 year period of active HU treatment. Those receiving care through specialized SCD clinics were less likely to have pain or acute care episodes(RR 5 0.79, P < 0.0001; RR 5 0.90, P 5 0.01). Compared with the non-HU cohort, the HU group evinced a significantly higher risk of experiencing vaso-occlusive pain episodes (RR 5 3.32, P < 0.0001)and ACS/pneumonia episodes (RR 5 2.66, P < 0.0001), and higher outpatient,inpatient/emergency, and total service costs (RR 5 1.85, 2.11,2.10, and P < 0.0001, respectively) over time. HU is clinically effective in reducing pain episodes, hospitalizations, and total care costs, but those receiving it might be more severely ill.

Publication types

  • Evaluation Study
  • Letter
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Chest Syndrome / economics
  • Acute Chest Syndrome / epidemiology
  • Acute Chest Syndrome / etiology
  • Acute Chest Syndrome / prevention & control
  • Adolescent
  • Anemia, Sickle Cell / complications
  • Anemia, Sickle Cell / drug therapy*
  • Anemia, Sickle Cell / economics
  • Anemia, Sickle Cell / epidemiology
  • Child
  • Child, Preschool
  • Cohort Studies
  • Cost-Benefit Analysis
  • Costs and Cost Analysis
  • Emergency Service, Hospital / economics
  • Emergency Service, Hospital / statistics & numerical data
  • Female
  • Hospital Costs
  • Hospitalization / economics
  • Hospitalization / statistics & numerical data*
  • Humans
  • Hydroxyurea / economics
  • Hydroxyurea / therapeutic use*
  • Male
  • Medicaid / statistics & numerical data
  • Outpatient Clinics, Hospital / economics
  • Outpatient Clinics, Hospital / statistics & numerical data
  • Pain / economics
  • Pain / epidemiology
  • Pain / etiology
  • Pain / prevention & control*
  • Poverty
  • South Carolina / epidemiology
  • United States

Substances

  • Hydroxyurea