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Amini A, Taherifard E, Akbari M, Taherifard E, Dehdari Ebrahimi N, Rajabi MR, Zamani F, Rekabpour SJ, Jafaraghaie R, Hassanzadeh J, Molavi Vardanjani H. The medication usage pattern and prevalence of polypharmacy among patients with sickle cell disease: a population-based study in southern Iran. Expert Rev Hematol 2024; 17:643-650. [PMID: 39061121 DOI: 10.1080/17474086.2024.2385482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 06/17/2024] [Accepted: 07/23/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Due to the numerous complications associated with sickle cell disease (SCD), patients often receive a variety of medications alongside their SCD treatment. However, a notable gap exists in the current literature regarding medication use patterns among them. This study aimed to investigate medication usage patterns in patients with SCD. RESEARCH DESIGN AND METHODS This cross-sectional study, conducted in Bushehr Province, employed a stratified random sampling method to select eligible participants with SCD. A thorough interview gathered various information, including details about the medications. The Anatomical Therapeutic Chemical classification system was utilized for drug classification. Polypharmacy was defined as the concurrent use of at least five medications. RESULTS A total of 300 individuals with SCD were included in this study. Polypharmacy was observed in 26.3% (95% CI: 20.8%-32.8%) of the study population. The analyses revealed positive associations between the use of more concurrent medication use and higher age groups and having multimorbidity. Antianemic preparations (86.7%), antineoplastic agents (58.3%), and vitamins (41.0%) were the most frequent medication classes used by the study participants. CONCLUSIONS Our study revealed notable underutilization of hydroxyurea and a high rate of polypharmacy, associated with age and multimorbidity, among patients with SCD in southern Iran.
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Affiliation(s)
- Abdullah Amini
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Erfan Taherifard
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammadreza Akbari
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Taherifard
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Fahimeh Zamani
- Department of Nursing, Kazerun Branch, Islamic Azad University, Kazerun, Iran
| | - Seyed Javad Rekabpour
- Department of Hematology and Oncology, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Razieh Jafaraghaie
- Department of Mathematics and Statistics, Shoushtar Branch, Islamic Azad University, Shoushtar, Iran
| | - Jafar Hassanzadeh
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hossein Molavi Vardanjani
- MPH Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
- Research Center for Traditional Medicine and History of Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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Ericksen PN, Dabbous F, Ghosh R, Shah S, Sun X, Meier ER, Colavecchia C. Standardization of coding definitions for sickle cell disease complications: A systematic literature review. Pharmacoepidemiol Drug Saf 2024; 33:e5769. [PMID: 39205482 DOI: 10.1002/pds.5769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 09/04/2024]
Abstract
PURPOSE Sickle cell disease (SCD) affects all organ systems and is characterized by numerous acute and chronic complications and comorbidities. Standardized codes are needed for complications/comorbidities used in real-world evidence (RWE) studies that rely on administrative and medical coding. This systematic literature review was conducted to produce a comprehensive list of complications/comorbidities associated with SCD, along with their diagnosis codes used in RWE studies. METHODS A search in MEDLINE and Embase identified studies published from 2016 to 2023. Studies were included if they were conducted in US SCD populations and reported complications/comorbidities and respective International Classification of Diseases, Clinical Modification (ICD-CM) codes. All identified complications/comorbidities and codes were reviewed by a certified medical coding expert and hematologist. RESULTS Of 1851 identified studies, 39 studies were included. The most reported complications/comorbidities were stroke, acute chest syndrome, pulmonary embolism, venous thromboembolism, and vaso-occlusive crisis. Most of the studies used ICD-9-CM codes (n = 21), while some studies used ICD-10-CM codes (n = 3) or both (n = 15), depending on the study period. Most codes reported in literature were heterogeneous across complications/comorbidities. The medical coding expert and hematologist recommended modifications for several conditions. CONCLUSION While many studies we identified did not report their codes and were excluded from this review, the studies with codes exhibited diverse coding definitions. By providing a standardized set of diagnosis codes that were reported by studies and reviewed by a coding expert and hematologist, our review can serve as a foundation for accurately identifying complications/comorbidities in future research, and may reduce heterogeneity, enhance transparency, and improve reproducibility. Future efforts focused on validating these code lists are needed.
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Affiliation(s)
| | - Firas Dabbous
- Data Analytics - Real World Evidence, Evidera, Bethesda, Maryland, USA
| | - Rajrupa Ghosh
- Data Analytics - Real World Evidence, Evidera, Bethesda, Maryland, USA
| | - Surbhi Shah
- Data Analytics - Real World Evidence, Evidera, Bethesda, Maryland, USA
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Walden J, Brown L, Seiguer S, Munshaw K, Rausch J, Badawy S, McGann P, Winkler S, Gonzalez L, Creary S. Study protocol for ADHERE (Applying Directly observed therapy to HydroxyurEa to Realize Effectiveness): Using small business partnerships to deliver a scalable and novel hydroxyurea adherence solution to youth with sickle cell disease. PLoS One 2024; 19:e0304644. [PMID: 38917111 PMCID: PMC11198815 DOI: 10.1371/journal.pone.0304644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 06/27/2024] Open
Abstract
Sickle cell disease (SCD) is an inherited blood disorder that affects approximately 100,000 Americans, primarily from underrepresented racial minority populations, and results in costly, multi-organ complications. Hydroxyurea, the primary disease-modifying therapy for SCD, is effective at reducing most complications; however, adherence to hydroxyurea remains suboptimal and is the primary barrier to clinical effectiveness. Video directly observed therapy (VDOT) has shown promise as an adherence-promoting intervention for hydroxyurea, yet previous VDOT trials were limited by high attrition from gaps in technology access, use of unvalidated adherence measures, and healthcare system limitations of delivering VDOT to patients. As such, we fostered a small business partnership to compare VDOT for hydroxyurea to attention control to address previous shortcomings, promote equitable trial participation, and maximize scalability. VDOT will be administered by Scene Health (formerly emocha Health) and adherence monitoring will be performed using a novel electronic adherence monitor developed to meet the unique needs of the target population. Adolescent and young adult patients as well as caregivers of younger patients (<11 years of age) will be recruited. In addition to visit incentives, all participants will be offered a smartphone with a data plan to ensure all participants have equal opportunity to complete study activities. The primary objectives of this pilot, multi-center, randomized controlled trial (RCT) are to assess retention and sustained engagement and to explore needs and preferences for longer-term adherence monitoring and interventions. This RCT is registered with the National Institutes of Health (NCT06264700). Findings will inform a future efficacy RCT applying VDOT to hydroxyurea to address adherence gaps and improve outcomes within this vulnerable population.
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Affiliation(s)
- Joseph Walden
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
| | - Lauren Brown
- emocha Mobile Health Inc. Doing Business as Scene and Scene Health, Baltimore, MD, United States of America
| | - Sebastian Seiguer
- emocha Mobile Health Inc. Doing Business as Scene and Scene Health, Baltimore, MD, United States of America
| | - Katie Munshaw
- emocha Mobile Health Inc. Doing Business as Scene and Scene Health, Baltimore, MD, United States of America
| | - Joseph Rausch
- Center for Biobehavioral Health, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States of America
| | - Sherif Badawy
- Division of Hematology, Oncology, and Stem Cell Transplant, Lurie Children’s Hospital of Chicago, Chicago, IL, United States of America
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, United States of America
| | - Patrick McGann
- Lifespan Comprehensive Sickle Cell Center, Providence, RI, United States of America
- The Warren Alpert Medical School of Brown University, Providence, RI, United States of America
| | - Savannah Winkler
- Division of Hematology, Oncology, and Stem Cell Transplant, Lurie Children’s Hospital of Chicago, Chicago, IL, United States of America
| | - Lisbel Gonzalez
- Lifespan Comprehensive Sickle Cell Center, Providence, RI, United States of America
| | - Susan Creary
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, United States of America
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, United States of America
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Herring WL, Gallagher ME, Shah N, Morse KC, Mladsi D, Dong OM, Chawla A, Leiding JW, Zhang L, Paramore C, Andemariam B. Cost-Effectiveness of Lovotibeglogene Autotemcel (Lovo-Cel) Gene Therapy for Patients with Sickle Cell Disease and Recurrent Vaso-Occlusive Events in the United States. PHARMACOECONOMICS 2024; 42:693-714. [PMID: 38684631 PMCID: PMC11126463 DOI: 10.1007/s40273-024-01385-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/20/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND AND OBJECTIVE Gene therapies for sickle cell disease (SCD) may offer meaningful benefits for patients and society. This study evaluated the cost-effectiveness of lovotibeglogene autotemcel (lovo-cel), a one-time gene therapy administered via autologous hematopoietic stem cell transplantation, compared with common care for patients in the United States (US) with SCD aged ≥ 12 years with ≥ 4 vaso-occlusive events (VOEs) in the past 24 months. METHODS We developed a patient-level simulation model accounting for lovo-cel and SCD-related events, complications, and mortality over a lifetime time horizon. The pivotal phase 1/2 HGB-206 clinical trial (NCT02140554) served as the basis for lovo-cel efficacy and safety. Cost, quality-of-life, and other clinical data were sourced from HGB-206 data and the literature. Analyses were conducted from US societal and third-party payer perspectives. Uncertainty was assessed through probabilistic sensitivity analysis and extensive scenario analyses. RESULTS Patients treated with lovo-cel were predicted to survive 23.84 years longer on average (standard deviation [SD], 12.80) versus common care (life expectancy, 62.24 versus 38.40 years), with associated discounted patient quality-adjusted life-year (QALY) gains of 10.20 (SD, 4.10) and direct costs avoided of $1,329,201 (SD, $1,346,446) per patient. Predicted societal benefits included discounted caregiver QALY losses avoided of 1.19 (SD, 1.38) and indirect costs avoided of $540,416 (SD, $262,353) per patient. Including lovo-cel costs ($3,282,009 [SD, $29,690] per patient) resulted in incremental cost-effectiveness ratios of $191,519 and $124,051 per QALY gained from third-party payer and societal perspectives, respectively. In scenario analyses, the predicted cost-effectiveness of lovo-cel also was sensitive to baseline age and VOE frequency and to the proportion of patients achieving and maintaining complete resolution of VOEs. CONCLUSIONS Our analysis of lovo-cel gene therapy compared with common care for patients in the US with SCD with recurrent VOEs estimated meaningful improvements in survival, quality of life, and other clinical outcomes accompanied by increased overall costs for the health care system and for broader society. The predicted economic value of lovo-cel gene therapy was influenced by uncertainty in long-term clinical effects and by positive spillover effects on patient productivity and caregiver burden.
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Affiliation(s)
- William L Herring
- Health Economics, RTI Health Solutions, Research Triangle Park, NC, USA.
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | | | - Nirmish Shah
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - K C Morse
- Theatre Management and Producing, Columbia University School of the Arts, New York, NY, USA
| | - Deirdre Mladsi
- Health Economics, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Olivia M Dong
- Health Economics, RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | - Lixin Zhang
- Biostatistics, bluebird bio, Somerville, MA, USA
| | | | - Biree Andemariam
- New England Sickle Cell Institute, University of Connecticut Health, Farmington, CT, USA
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Roessner C, Sale T, Uminski K, Goodyear D, Rydz N. A Pharmacist-Managed Hydroxyurea Prescribing Protocol Improves Uptake and Optimization among Patients with Sickle Cell Disease. Adv Hematol 2024; 2024:4753349. [PMID: 38912090 PMCID: PMC11192600 DOI: 10.1155/2024/4753349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 06/25/2024] Open
Abstract
Sickle cell disease (SCD) is a common genetic disorder with potentially serious sequelae that can be effectively treated with hydroxyurea. Despite its favorable benefit-risk profile, hydroxyurea uptake in patients with SCD is low. A pilot study was conducted at the Southern Alberta Rare Blood and Bleeding Disorders (SARBBDs) Comprehensive Care Program between January 2020 and September 2023 to assess the implementation of a pharmacist-led protocol for supporting the uptake of hydroxyurea among eligible patients with SCD and optimizing its dosing. The protocol standardized the prescription, monitoring, dose titration, and patient counselling by a clinic pharmacist. The number of patients enrolled in the SARBBDs program increased from 98 in January 2020 to 168 in 2023. During this period, the proportion of patients on hydroxyurea increased from 37.8% to 62.5%, the proportion of patients on hydroxyurea who were at a maximum tolerated dose (MTD) increased from 35.1% to 63.8%, and the average hemoglobin F level increased from 13.9% to 19.7%. The mean time to reach MTD was 10 months and required eight pharmacist interventions, six laboratory assessments, and three dose increases. Hydroxyurea continuation rates were high, with most discontinuations resulting from loss to follow-up or transition to a transfusion management strategy. This real-world pilot study demonstrated that implementation of a pharmacist-led prescribing and monitoring protocol nearly doubled hydroxyurea uptake and achievement of MTD in patients with SCD managed in a rare blood disorders clinic.
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Affiliation(s)
- Cameron Roessner
- Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Foothills Medical Center, Calgary, AB, Canada
- Pharmacy Services, Foothills Medical Center, Calgary, AB, Canada
| | - Trudy Sale
- Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Foothills Medical Center, Calgary, AB, Canada
| | - Kelsey Uminski
- Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Foothills Medical Center, Calgary, AB, Canada
- Department of Medicine, Division of Hematology and Hematological Malignancies, University of Calgary, Calgary, AB, Canada
| | - Dawn Goodyear
- Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Foothills Medical Center, Calgary, AB, Canada
- Department of Medicine, Division of Hematology and Hematological Malignancies, University of Calgary, Calgary, AB, Canada
| | - Natalia Rydz
- Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Foothills Medical Center, Calgary, AB, Canada
- Department of Medicine, Division of Hematology and Hematological Malignancies, University of Calgary, Calgary, AB, Canada
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6
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MacEwan SR, Chiang C, O’Brien SH, Creary S, Lin CJ, Hyer JM, Cronin RM. Comparing super-utilizers and lower-utilizers among commercial- and Medicare-insured adults with sickle cell disease. Blood Adv 2024; 8:224-233. [PMID: 37991988 PMCID: PMC10805643 DOI: 10.1182/bloodadvances.2023010813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 11/24/2023] Open
Abstract
ABSTRACT Sickle cell disease (SCD) is a rare but costly condition in the United States. Super-utilizers have been defined as a subset of the population with high health care encounters or expenditures. Although super-utilizers have been described in other disease states, little is known about super-utilizers among adults with SCD. This study aimed to characterize the differences in expenditures, overall health care encounters, and pain episode encounters between super-utilizers (top 10% expenditures) and lower-utilizers with SCD (high, top 10%-24.9%; moderate, 25%-49.9%; and low, bottom 50% expenditures). A retrospective longitudinal cohort of adults with SCD were identified using validated algorithms in MarketScan and Medicare claim databases from 2016 to 2020. Encounters and expenditures were analyzed from inpatient, outpatient, and emergency department settings. Differences in encounters and expenditures between lower-utilizers and super-utilizers were compared using logistic regression. Among super-utilizers, differences in encounters and expenditures were compared according to incidences of pain episode encounters. The study population included 5666 patients with commercial insurance and 8600 with Medicare. Adjusted total annual health care expenditure was 43.46 times higher for super-utilizers than for low-utilizers among commercial-insured and 13.37 times higher in Medicare-insured patients. Among super-utilizers, there were patients with few pain episode encounters who had higher outpatient expenditures than patients with a high number of pain episode encounters. Our findings demonstrate the contribution of expensive outpatient care among SCD super-utilizers, in which analyses of high expenditure have largely focused on short-term care. Future studies are needed to better understand super-utilizers in the SCD population to inform the effective use of preventive interventions and/or curative therapies.
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Affiliation(s)
- Sarah R. MacEwan
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH
| | - ChienWei Chiang
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
- Secondary Data Core, Center for Clinical and Translational Science, The Ohio State University, Columbus, OH
| | - Sarah H. O’Brien
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | - Susan Creary
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH
| | | | - J. Madison Hyer
- Secondary Data Core, Center for Clinical and Translational Science, The Ohio State University, Columbus, OH
- Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH
| | - Robert M. Cronin
- Division of General Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
- Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, OH
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