OBJECTIVES: To compare all-cause and thalassemia-related healthcare resource utilization (RU) and costs in thalassemia patients who are adherent vs. non-adherent to iron chelation therapy (ICT).

METHODS: Healthcare claims databases from six state Medicaid programs (Florida, Iowa, Kansas, Mississippi, Missouri, and New Jersey) (1997-2013) were analyzed. Patients with ≥1thalassemia ICD-9 diagnosis code, ≥2 dispensings for deferoxamine or deferasirox, and ≥6 months of continuous enrollment before first ICT dispensing were included. Adherence was defined as a medication possession ratio ≥0.80. All-cause and thalassemia-related RU and costs were evaluated per-patient-per-month (PPPM) during the treatment period. Adherent and non-adherent patients were compared using adjusted incidence rate ratios (aIRR) for RU, and adjusted cost differences (aCD). RESULTS: Of the 218 eligible thalassemia patients, 137(62.8%) were adherent. Baseline demographic and clinical characteristics were similar between adherent and non-adherent patients, although adherent patients were younger (20.9 vs. 25.8 years old, p=0.011). The adjusted rate of thalassemia-related outpatient visits PPPM was higher in adherent patients (aIRR: 1.11, p=0.004). However, adherent patients incurred fewer thalassemia-related hospitalizations (0.80, p=0.002) and ER visits (0.64, p<0.001). PPPM thalassemia-related medical costs followed a similar trend with slightly higher outpatient costs (aCD: $113, p=0.504) and lower total costs (aCD: -$1,922, p=0.056), mainly driven by lower inpatient costs (aCD: -$2,504, p=0.052). Similar results were observed for all-cause RU and medical costs. While all-cause pharmacy costs were higher in adherent patients (aCD: $1,506, p<0.001), non-ICT pharmacy costs was slightly lower (-$234, p=0.200). CONCLUSIONS: This study shows that thalassemia patients adherent to ICT incurred more outpatient visits, which may be related to better disease monitoring and management, potentially resulting in the lower rates of acute care visits and related costs observed in this cohort. Enhanced adherence to ICT may reduce downstream costs associated with acute care, thereby reducing the financial burden of thalassemia from a payer’s perspective.