(DOWNLOAD) "Medication Adherence and Associated Outcomes in Medicaid Enrollees with Sickle Cell Disease" by Sean David Candrilli ~ Book PDF Kindle ePub Free
eBook details
- Title: Medication Adherence and Associated Outcomes in Medicaid Enrollees with Sickle Cell Disease
- Author : Sean David Candrilli
- Release Date : January 18, 2013
- Genre: Medical,Books,Professional & Technical,
- Pages : * pages
- Size : 12262 KB
Description
Background and Objective: Sickle cell disease (SCD) is an inherited disorder characterized by the production of defective hemoglobin, which in turn leads to the formation of sickle-shaped red blood cells (RBCs). Predominantly affecting people of African descent, it is estimated that between 50,000 and 100,000 people in the United States (US) are afflicted with the disease, with approximately 2,000 new cases arising each. Patients with SCD frequently experience unexpected, intermittent, and sometimes life-threatening complications leading to increased numbers of emergency room visits and frequent hospitalizations, each with substantial economic costs. In the US alone, SCD-related inpatient costs alone are estimated to be between $500 million and $1 billion annually. Hydroxyurea (HU) is the only pharmacologic intervention approved for the treatment of HU. There is a paucity of data on of the use of HU in real-world settings among SCD populations. Further, little research exists on the extent, and implications, of HU nonadherence among SCD patients. The aim of this study was to assess the association between HU adherence and outcomes in a Medicaid-enrolled SCD population.Methods: Retrospective claims of enrollees in the North Carolina Medicaid program (6/1999 – 8/2008) were analyzed. Inclusion criteria were: ≥1 encounter with a diagnosis for SCD, ≥2 HU prescriptions; and continuous health plan enrollment for ≥12 months prior to and following HU initiation (index). Adherence was measured using the medication possession ratio (MPR), defined as the sum of HU days supplied during the 12 months following initiation divided by the number of days (365) in the follow-up period, less the number of days hospitalized. Patients with an MPR ≥0.8 were classified as adherent. Multivariate regression analyses were used to estimate the effect HU adherence on economic and clinical outcomes (e.g., costs, likelihood of event). Covariates included age, gender, race, Charlson Comorbidity Index score, and the number of SCD-related office visits in the year prior to HU initiation.Results: Three hundred and twelve subjects (51% male, 83% Black, mean age 21 years) met all inclusion criteria. Mean MPR was 0.60, and only 35% of subjects were adherent. Multivariate regression models suggest that HU adherence is significantly associated with a reduction in both all-cause and SCD-related inpatient and emergency room costs, as well as SCD-related total costs; adherence was also associated with an increase in HU and, interestingly, all-cause office visit costs. Finally, adherence was associated with a reduction in the likelihood of having an ER visit or inpatient stay, regardless of the primary reason for the encounter, as well as the likelihood of having a vaso-occlusive event.Conclusions: Adherence to HU in the analyzed SCD population is low. These data suggest, though, that increasing adherence may be associated with improved outcomes, both clinical and economic.
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