OBJECTIVES

Sickle cell disease (SCD) is an inherited, chronic disorder characterized by symptoms such as vaso-occlusive crises, acute chest syndrome, and leg ulcers, resulting in significant healthcare burden. Hydroxyurea (HU), opioid and non-opioid analgesics are common medications used to manage SCD complications. However, little is known regarding the SCD-related prescription medication utilization among patients of different age groups. The study examined whether there are differences in: 1) SCD index therapy type by age group and 2) SCD-related prescription medication utilization by age group.

METHODS

This retrospective study included continuously enrolled Texas Medicaid patients aged 2 to 63 years with one inpatient or one outpatient SCD-related diagnosis and at least one pharmacy claim for HU, opioid or non-opioid analgesic. The study period ranged from 3/1/2012–8/31/2016 and patients were followed 12 months after the index date (first SCD-related prescription claim). Dependent variables included index medication type (HU, opioids, non-opioids, dual therapy), medication utilization (HU adherence, and opioid/non-opioid total days’ supply). The independent variable was age group. Chi-square, ANOVA and Kruskal-Wallis tests were used.

RESULTS

Of included patients (N=2,339), there was a significant difference in SCD index therapy type by age-group (χ² = 243.0, p <.0001). Higher proportion of children (2-12: 9.1%) used HU as index therapy as compared to adults (26-40: 3.7%; 41-63: 2.9%). Higher proportion adults (18-25: 48.0%; 26-40: 54.9%; 41-63: 65.2%) used opioids as index therapy as compared to children (2-12: 36.6%). Mean HU adherence was higher (p<.0001) for younger ages and mean opioid days’ supply was higher for older ages.

CONCLUSIONS

This study identified suboptimal HU use and adherence among all age groups. With significant SCD-related resource burden, the opioid epidemic and new SCD medications emerging, it is imperative to develop age-specific interventions and strategies for optimal SCD management.