Age-related prescription medication utilization for the management of sickle cell disease among Texas Medicaid patients

Nidhi Shukla, MS, MBA; Jamie C. Barner, PhD, FAACP, FAPhA; Kenneth A. Lawson, PhD, FAPhA; Karen L. Rascati, PhD

doi:10.5055/jom.2021.0662

Authors

Nidhi Shukla, MS, MBA https://orcid.org/0000-0002-7581-3861
Jamie C. Barner, PhD, FAACP, FAPhA
Kenneth A. Lawson, PhD, FAPhA
Karen L. Rascati, PhD

DOI:

https://doi.org/10.5055/jom.2021.0662

Keywords:

sickle cell disease, opioid, hydroxyurea adherence

Abstract

Introduction: Sickle cell disease (SCD) is associated with recurrent complications and healthcare burden. Although SCD management guidelines differ based on age groups, little is known regarding actual utilization of preventative (hydroxyurea) and palliative therapies (opioid and nonopioid analgesics) to manage complications. This study assessed whether there were age-related differences in SCD index therapy type and SCD-related medication utilization.

Design and patients: Texas Medicaid prescription claims from September 1, 2011 to August 31, 2016 were retrospectively analyzed for SCD patients aged 2-63 years who received one or more SCD-related medications (hydroxyurea, opioid, or nonopioid analgesics).

Outcome measures: The primary outcomes were SCD index drug type and medication utilization: hydroxyurea adherence, and days’ supply of opioid, and nonopioid analgesics. Chi-square, analysis of variance, and Kruskal–Wallis tests were used.

Results: Index therapy percentages for included patients (N = 2,339) were the following: opioids (45.7 percent), nonopioids (36.6 percent), dual therapy-opioids and nonopioids (11.2 percent), and hydroxyurea (6.5 percent), and they differed by age-groups (χ2 = 243.0, p < 0.0001). Hydroxyurea as index therapy was higher among children (2-12:9.1 percent) compared to adults (26-40:3.7 percent; 41-63:2.9 percent). Opioids as index therapy were higher among adults (18-25:48.0 percent; 26-40:54.9 percent; 41-63:65.2 percent) compared to children (2-12:36.6 percent). Mean hydroxyurea adherence was higher (p < 0.0001) for younger ages, and opioid days’ supply was higher for older ages.

Conclusions: Texas Medicaid SCD patients had low hydroxyurea utilization and adherence across all age groups. Interventions to increase the use of hydroxyurea and newer preventative therapies could result in better management of SCDrelated complications and reduce the frequency of pain crises, which may reduce the need for opioid use.

Author Biographies

Nidhi Shukla, MS, MBA

Graduate Student, College of Pharmacy, The University of Texas at Austin, Austin, Texas

Jamie C. Barner, PhD, FAACP, FAPhA

Professor & Division Head of Health Outcomes, College of Pharmacy, The University of Texas at Austin, Austin, Texas

Kenneth A. Lawson, PhD, FAPhA

Professor, College of Pharmacy, The University of Texas at Austin, Austin, Texas

Karen L. Rascati, PhD

Graduate Advisor & Professor, College of Pharmacy, The University of Texas at Austin, Austin, Texas

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