Changes in Hydroxyurea Use Among Youths Enrolled in Medicaid With Sickle Cell Anemia After 2014 Revision of Clinical Guidelines.
Changes in Hydroxyurea Use Among Youths Enrolled in Medicaid With Sickle Cell Anemia After 2014 Revision of Clinical Guidelines.
复制标题
DOI：
10.1001/jamanetworkopen.2023.4584
复制
发表时间：
2023-03-01
影响因子：
13.8
通讯作者：
Dombkowski, Kevin J.
中科院分区：
文献类型：
--
作者：
Reeves, Sarah L.;Peng, Hannah K.;Wing, Jeffrey J.;Cogan, Lindsay W.;Goel, Alka;Anders, David;Green, Nancy S.;Lisabeth, Lynda D.;Dombkowski, Kevin J.
这项横断面研究调查了在2014年修订临床指南后，由医疗补助计划投保的镰状细胞性贫血青少年中使用羟基脲的变化。在密歇根州和纽约州，在国家心脏、肺和血液研究所于2014年发布修订后的临床指南后，接受医疗补助的镰状细胞性贫血（SCA）青少年中，羟基脲的使用情况发生了怎样的变化？在这项对4302名SCA青少年的横断面研究中，密歇根州的羟基脲非零日供应量的几率增加;然而，在纽约州，未观察到填充羟基脲处方的平均日供应量变化。这些发现表明，增加羟基脲的使用可能需要多方面的方法，解决多个系统和患者层面的障碍。患有镰状细胞性贫血（SCA）的年轻人有疼痛危机，中风和早期死亡的风险。并发症可以通过口服疾病缓解药物羟基脲来减少，2014年，国家心脏，肺和血液研究所发布了修订后的指南，即应向9个月及以上患有SCA的青少年提供羟基脲，无论疾病严重程度如何。描述国家心肺血液研究所指南发布前后SCA青少年中羟基脲使用的变化。这项横断面研究使用密歇根州和纽约州（NYS）医疗补助计划2010年至2018年的行政数据进行。研究人群包括1至17岁的青少年，SCA参加了密歇根州或纽约州医疗补助计划至少1年（密歇根州：2010-2018;纽约州：2012-2018）。SCA青少年是使用经过验证的基于声明的定义确定的。数据分析时间为2020年6月至10月。主要结局是以平均每年供应满剂量的羟基脲处方天数为特征的羟基脲使用情况。使用回归模型（密歇根州：零膨胀负二项;纽约州：负二项）评估了一段时间内的羟基脲使用率。模型包括指南发布前后的指标。共有4302名SCA青年（2236名男性[52.0%]; 2676名出生于2005-2017年[62.2%]; 150名西班牙裔[3.5%]，2929名非西班牙裔黑人[68.0%]和389名非西班牙裔白色[9.0%]）贡献了12565人年。密歇根州和纽约州的平均（SD）年供应量分别为47.2（93.6）天和97.4（137.0）天。在密歇根州，指南发布后，非零日供应的几率增加（比值比，1.52; 95%CI，1.07-2.14）。在纽约州，填充型羟基脲的平均供应天数没有变化。这些结果表明，尽管已确立为SCA的主要疾病缓解疗法，但在SCA青少年中，羟基脲的使用率显著不足，并且临床医生或患者对新发布的指南的接受程度不完全。结果表明，扩大使用羟基脲可能需要多方面的方法，包括解决多个系统和患者层面的障碍。
This cross-sectional study investigates changes in the use of hydroxyurea among youths insured by Medicaid with sickle cell anemia after the 2014 revision of clinical guidelines. How did hydroxyurea use change among youths insured by Medicaid with sickle cell anemia (SCA) in Michigan and New York State after the National Heart, Lung, and Blood Institute released revised clinical guidelines in 2014? In this cross-sectional study of 4302 youths with SCA, there was an increase in the odds of having nonzero days’ supply of hydroxyurea in Michigan; however, in New York State, no change was seen in mean days’ supply of filled hydroxyurea prescriptions. These findings suggest that increasing hydroxyurea use may require a multifaceted approach that addresses multiple system- and patient-level barriers. Youths with sickle cell anemia (SCA) are at risk of pain crises, stroke, and early death. Complications can be reduced by the oral disease-modifying medication hydroxyurea, and in 2014, the National Heart, Lung, and Blood Institute published revised guidelines that hydroxyurea should be offered to youths aged 9 months and older with SCA regardless of disease severity. To describe changes in hydroxyurea use among youths with SCA before and after release of the National Heart, Lung, and Blood Institute guidelines. This cross-sectional study was conducted using administrative data from 2010 to 2018 from Michigan and New York State (NYS) Medicaid programs. The study population included youths aged 1 to 17 years with SCA enrolled in the Michigan or NYS Medicaid programs for at least 1 year (Michigan: 2010-2018; NYS: 2012-2018). Youths with SCA were identified using validated claims–based definitions. Data were analyzed from June to October 2020. The main outcome was hydroxyurea use characterized as mean annual counts of days’ supply of filled hydroxyurea prescriptions. Rates of hydroxyurea use over time were assessed using regression models (Michigan: zero-inflated negative binomial; NYS: negative binomial). Models included indicators for periods before and after guideline release. A total of 4302 youths with SCA (2236 males [52.0%]; 2676 born 2005-2017 [62.2%]; 150 Hispanic [3.5%], 2929 non-Hispanic Black [68.0%], and 389 non-Hispanic White [9.0%]) contributed 12 565 person-years. The mean (SD) annual days’ supply of hydroxyurea was 47.2 (93.6) days per youth in Michigan and 97.4 (137.0) days per youth in NYS. In Michigan, there was an increase in the odds of having nonzero days’ supply after the guidelines were released (odds ratio, 1.52; 95% CI, 1.07-2.14). In NYS, no change was seen in the mean days’ supply of filled hydroxyurea. These findings suggest that hydroxyurea was substantially underused among youths with SCA, despite establishment as the primary disease-modifying therapy for SCA, and that there was incomplete clinician or patient uptake of newly released guidelines. Results suggest that expanding use of hydroxyurea may require a multifaceted approach that includes addressing multiple system- and patient-level barriers.
登录
查看更多内容
DOI：
10.3122/jabfm.2020.01.190143
发表时间：
2020-01
期刊：
Journal of the American Board of Family Medicine : JABFM
影响因子：
--
作者：
Crego N;Douglas C;Bonnabeau E;Earls M;Eason K;Merwin E;Rains G;Tanabe P;Shah N
通讯作者：
Shah N
DOI：
10.5409/wjcp.v5.i1.25
发表时间：
2016-02-08
期刊：
World journal of clinical pediatrics
影响因子：
--
作者：
Iughetti, Lorenzo;Bigi, Elena;Venturelli, Donatella
通讯作者：
Venturelli, Donatella
影响因子：
5.5
作者：
Anders, David G.;Tang, Fei;Sturman, Lawrence S.
通讯作者：
Sturman, Lawrence S.
影响因子：
5
作者：
Creary, Susan;Chisolm, Deena;O'Brien, Sarah H.
通讯作者：
O'Brien, Sarah H.
影响因子：
3.2
作者：
Bou-Maroun, Laura M.;Meta, Fabien;Yanik, Gregory A.
通讯作者：
Yanik, Gregory A.