Hydroxyurea Use in Young Children With Sickle Cell Anemia in New York State
Hydroxyurea Use in Young Children With Sickle Cell Anemia in New York State
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DOI：
10.1016/j.amepre.2016.01.001
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发表时间：
2016-07-01
影响因子：
5.5
通讯作者：
Sturman, Lawrence S.
中科院分区：
文献类型：
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作者：
Anders, David G.;Tang, Fei;Sturman, Lawrence S.
简介：本研究调查了纽约州（NYS）内患有镰状细胞贫血的幼儿使用羟基脲的情况。该队列是273名镰状细胞性贫血的儿童出生在纽约州在2006-2009年，基本上连续参加医疗补助的前4年的生命。方法：医疗补助的数据被用来检查在这一组的年龄在第一次处方填写，持久性，地区，治疗机构，和年的羟基脲的使用。使用对数二项式回归模型估计接受羟基脲治疗的可能性。2015年，收集并分析了研究组所有成员从出生到2014年的数据。结果：大约25%的队列在5岁生日时至少有一个完整的羟基脲处方，在研究期结束时接近40%。治疗第一年覆盖天数的平均比例为56.3%。还通过计算各个治疗阶段的药物拥有率来评估依从性。略多于三分之一的接受治疗的儿童显示这些措施的覆盖率为80%。有一个一致的，但不具有统计学意义的趋势，在第一次填充的年轻化。显着的区域和治疗中心的差异，在开始使用羟基脲，但不持久后，开始，注意到之间NYS centers.Conclusions：临床研究证明安全性后，目前纽约州广泛使用的羟基脲在幼儿镰状细胞性贫血似乎是广泛的，并不断增加。然而，治疗中心之间的实践差异和依从性不足可能会限制羟基脲的全部疾病改善作用。(C)2016年美国预防医学杂志。爱思唯尔公司出版
Introduction: This study examined hydroxyurea usage in young children with sickle cell anemia within New York State (NYS). The cohort was 273 children with sickle cell anemia born in NYS in 2006-2009 and enrolled essentially continuously in Medicaid for the first 4 years of life.Methods: Medicaid data were used to examine hydroxyurea usage in this group by age at first prescription fill, persistence, region, treatment institution, and year. Log-binomial regression models were used to estimate the likelihood of receiving hydroxyurea treatment. Data from birth through 2014 for all members of the study group were assembled and analyzed in 2015.Results: About 25% of the cohort had at least one filled hydroxyurea prescription by their fifth birthday, and nearly 40% by the end of the study period. The mean proportion of days covered for the first year of therapy was 56.3%. Adherence was also assessed by calculating medication possession ratios for individual treatment periods. Slightly more than one third of treated children showed 80% coverage by these measures. There was a consistent, but not statistically significant, trend toward younger age at first fill. Significant regional and treatment center differences in initiation of hydroxyurea use, but not in persistence after initiation, were noted among NYS centers.Conclusions: Subsequent to clinical studies demonstrating safety, current NYS-wide use of hydroxyurea in young children with sickle cell anemia appears to be widespread and increasing. However, practice differences between treatment centers and inadequate adherence may limit the full disease-modifying effects of hydroxyurea. (C) 2016 American Journal of Preventive Medicine. Published by Elsevier Inc.