OBJECTIVES

This study aimed to provide policy makers a clearer understanding of the relative value of the two therapies in preventing complications in young patients diagnosed with sickle-cell anemia.

METHODS

Cost effectiveness analysis using decision tree model was used to compare costs and clinical outcome of the two therapies in preventing vaso-occlusive crises and acute chest syndrome. Hydroxyurea and l-glutamine preventing rates were obtained from the primary studies used by Food and Drug Administration indication approval. The annual costs for vaso-occlusive crises and acute chest syndrome were derived from Marketscan claims databases. The studied population consisted of <18 years old patients diagnosed with sickle cell anemia and have a history of at least two pain crises and/or acute chest syndrome during the past year.

RESULTS

Hydroxyurea cost approximately $4,456 more than l-glutamine per year and resulting in 30% lower chance of preventing unwanted sickle cell anemia per year. Hydroxyurea would cost extra $4,456 to prevent each additional sickle cell anemia complication per year with one third higher risk of acute chest syndrome compared to l-glutamine. Almost one third of hydroxyurea users are at higher risk for serious adverse events requiring hospitalization and extended hospital stay.

CONCLUSIONS

L-glutamine appears to be modest in preventing vaso-occlusive crisis and much more in preventing acute chest syndrome than hydroxyurea. L-glutamine is a good therapeutic option to hydroxyurea to minimize unacceptable adverse events/toxicity in young patients with sickle cell anemia.