P1084 - Hydroxyurea Use for Sickle Cell Anemia Patients is Underutilized Even Within a Universal Health Care System

Background: Sickle cell anemia (SCA) is a common hematologic disease in the US which results in severe morbidity and mortality affecting the African American population. Hydroxyurea is a safe and efficacious drug that decreases ischemic events and end-organ damage. Hydroxyurea was found in a randomized placebo controlled trial (BABY HUG) to be beneficial to children and was strongly recommended for pediatric use in 2014. There is concern that this therapy, now considered standard of care, remains underutilized.

Objective: We aim to describe hydroxyurea use for patients with SCA in a universal open-access health care system and describe factors related to disparities in its use.

Methods: Children aged 1-18 years old with a diagnosis of SCA were identified from military health system claims data from 2005-2017. SCA was identified by ICD9 and ICD10 codes. Patients received care at both military and civilian institutions and all patients received access to care without cost. Prescriptions for hydroxyurea were identified by American Hospital Formulary System prescription drug codes. The odds of being prescribed hydroxyurea were determined by logistic regression after adjustment for demographic factors and era effects. Socioeconomic status was determined by parent’s military rank.

Results: We identified 2,765 patients with SCA. The median age for initial enrollment in the military system was 3 years (interquartile range (IQR) 0-10 years) and 49.4% were female. 476 (17.2%) had a parent who was junior enlisted (JE), 1942 (70.2%) senior enlisted (SE), and 328 (11.9%) an officer. Any hydroxyurea use increased from 8.5% in 2005 to 14.4% in 2017 (OR 1.06 ([95% CI 1.03-1.08]). Median time from earliest diagnosis to prescription was 2.8 years (IQR 0.4-6.0 years).
With adjusted analysis, the odds of being prescribed hydroxyurea varied by increasing age (OR 1.11 [95% CI 1.09-1.13]) and Post (2016-2017) vs Pre (2005-2013) Baby HUG introduction (OR 1.93 [95% CI 1.61-2.32]). It was not significant for gender (OR 0.82 [95% CI 0.65-1.03]) or for parent rank (SE vs JE 1.29 [95% CI 0.94-1.77], Officer vs JE 1.54 [95% CI 0.74-3.22]).

Conclusion: Hydroxyurea use for children with SCA is increasing in the military healthcare system. There were no disparities in likelihood of hydroxyurea prescription based on gender or socioeconomic factors. However, despite minimal to no cost for prescription or subspecialty care, there continues to be an underutilization of this effective therapy. There exists overwhelming evidence regarding the benefit of hydroxyurea therapy in patients with SCA and improvements are needed to bring this life saving therapy to more patients.