Cost-effectiveness of hydroxyurea in sickle cell anemia

Richard D. Moore, Samuel Charache, Michael L. Terrin, Franca B. Barton, Samir K. Ballas, E. Orringer, S. Jones, D. Strayhorn, W. Rosse, G. Phillips, D. Peace, A. Johnson-Telfair, P. Milner, A. Kutlar, A. Tracy, S. K. Ballas, G. E. Allen, J. Moshang, B. Scott, M. Steinberg & 79 others A. Anderson, V. Sabahi, C. Pegelow, D. Temple, E. Case, R. Harrell, S. Childerie, S. Embury, B. Schmidt, D. Davies, M. Koshy, N. Talischy-Zahed, L. Dorn, G. Pendarvis, M. McGee, M. Telfer, A. Davis, O. Castro, H. Finke, E. Perlin, J. Siteman, P. Gascon, P. Di Paolo, S. Gargiulo, J. Eckman, J. H. Bailey, A. Platt, L. Waller, G. Ramirez, V. Knors, S. Hernandez, E. M. Rodriguez, E. Wilkes, E. Vichinsky, S. Claster, A. Earles, K. Kleman, K. McLaughlin, P. Swerdlow, W. Smith, B. Maddox, L. Usry, A. Brenner, K. Williams, R. O'Brien, K. Genther, S. Shurin, B. Berman, K. Chiarucci, L. Keverline, N. Olivieri, D. Shaw, N. Lewis, K. Bridges, B. Tynan, C. Winograd, R. Bellevue, H. Dosik, M. Sheikhai, P. Ryans, H. Souffrant, J. Prchal, J. Braddock, T. McArdle, T. Carlos, A. Schmotzer, D. Gardner, G. Dover, M. Bergner, C. Ewart, S. Eckert, C. Lent, J. Ullrich, L. Fishpaw, G. Tirado, J. Gibson, T. Moeller, T. Nagle, P. Luthra

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

The Multicenter Study of Hydroxyurea in Sickle Cell Anemia (MSH) demonstrated the efficacy of hydroxyurea in reducing the rate of painful crises compared to placebo. We used resource utilization data collected in the MSH to determine the cost-effectiveness of hydroxyurea. The MSH was a randomized, placebo-controlled double-blind clinical trial involving 299 patients at 21 sites. The primary outcome, visit to a medical facility, was one of the criteria to define occurrence of painful crisis. Cost estimates were applied to all outpatient and emergency department visits and inpatient hospital stays that were classified as a crisis. Other resources for which cost estimates were applied included hospitalization for chest syndrome, analgesics received, hydroxyurea dosing, laboratory testing, end clinic visits for management of patient care. Annualized differential costs were calculated between hydroxyurea- and placebo-receiving patients. Hospitalization for painful crisis accounted for the majority of costs in both arms of the study, with an annual mean of $12,160 (95% CI: $9,440, $14,880) for hydroxyurea and $17,290 (95% CI: $13,010, $21,570) for placebo. The difference in means was $5,130 (95% CI: $60, $10,200; P = 0.048). Chest syndrome was the next largest cost with a mean difference of $830 (95% CI: $- 340, $2,000; P = 0.16). The hydroxyurea arm was also associated with lower costs for emergency department visits, transfusion, and use of opiate analgesics, in total, the annual average cost per patient receiving hydroxyurea was $16,810 (95% CI: $13,350, $20,270) and the annual average costs per patient receiving placebo was $22,020 (95% CI: $17,340, $26,710). The difference in means was $45,210 (95% CI: $-810, $11,030; P = 0.21). The cost of hydroxyurea with the more intensive monitoring required when using this drug appears to be more than offset by decreased costs for medical care of painful crisis and analgesic use. Although the total cost difference was not significant statistically, these results suggest that hydroxyurea therapy is cost-effective compared to placebo in the management of adult patients with sickle cell anemia. If hydroxyurea can prevent development of chronic organ damage, long-term savings may be even greater. (C) Wiley-Liss, Inc.

Original languageEnglish
Pages (from-to)26-31
Number of pages6
JournalAmerican Journal of Hematology
Volume64
Issue number1
DOIs
StatePublished - May 9 2000
Externally publishedYes

Fingerprint

Hydroxyurea
Sickle Cell Anemia
Cost-Benefit Analysis
Costs and Cost Analysis
Placebos
Melanocyte-Stimulating Hormones
Analgesics
Hospital Emergency Service
Opiate Alkaloids
Hospitalization
Arm
Thorax
Patient Care Management
Ambulatory Care
Health Care Costs
Multicenter Studies
Inpatients
Length of Stay
Outpatients
Clinical Trials

Keywords

  • Cost-effectiveness
  • Hydroxyurea
  • Medical care costs
  • Sickle cell anemia

ASJC Scopus subject areas

  • Hematology

Cite this

Moore, R. D., Charache, S., Terrin, M. L., Barton, F. B., Ballas, S. K., Orringer, E., ... Luthra, P. (2000). Cost-effectiveness of hydroxyurea in sickle cell anemia. American Journal of Hematology, 64(1), 26-31. https://doi.org/10.1002/(SICI)1096-8652(200005)64:1<26::AID-AJH5>3.0.CO;2-F

Cost-effectiveness of hydroxyurea in sickle cell anemia. / Moore, Richard D.; Charache, Samuel; Terrin, Michael L.; Barton, Franca B.; Ballas, Samir K.; Orringer, E.; Jones, S.; Strayhorn, D.; Rosse, W.; Phillips, G.; Peace, D.; Johnson-Telfair, A.; Milner, P.; Kutlar, A.; Tracy, A.; Ballas, S. K.; Allen, G. E.; Moshang, J.; Scott, B.; Steinberg, M.; Anderson, A.; Sabahi, V.; Pegelow, C.; Temple, D.; Case, E.; Harrell, R.; Childerie, S.; Embury, S.; Schmidt, B.; Davies, D.; Koshy, M.; Talischy-Zahed, N.; Dorn, L.; Pendarvis, G.; McGee, M.; Telfer, M.; Davis, A.; Castro, O.; Finke, H.; Perlin, E.; Siteman, J.; Gascon, P.; Di Paolo, P.; Gargiulo, S.; Eckman, J.; Bailey, J. H.; Platt, A.; Waller, L.; Ramirez, G.; Knors, V.; Hernandez, S.; Rodriguez, E. M.; Wilkes, E.; Vichinsky, E.; Claster, S.; Earles, A.; Kleman, K.; McLaughlin, K.; Swerdlow, P.; Smith, W.; Maddox, B.; Usry, L.; Brenner, A.; Williams, K.; O'Brien, R.; Genther, K.; Shurin, S.; Berman, B.; Chiarucci, K.; Keverline, L.; Olivieri, N.; Shaw, D.; Lewis, N.; Bridges, K.; Tynan, B.; Winograd, C.; Bellevue, R.; Dosik, H.; Sheikhai, M.; Ryans, P.; Souffrant, H.; Prchal, J.; Braddock, J.; McArdle, T.; Carlos, T.; Schmotzer, A.; Gardner, D.; Dover, G.; Bergner, M.; Ewart, C.; Eckert, S.; Lent, C.; Ullrich, J.; Fishpaw, L.; Tirado, G.; Gibson, J.; Moeller, T.; Nagle, T.; Luthra, P.

In: American Journal of Hematology, Vol. 64, No. 1, 09.05.2000, p. 26-31.

Research output: Contribution to journalArticle

Moore, RD, Charache, S, Terrin, ML, Barton, FB, Ballas, SK, Orringer, E, Jones, S, Strayhorn, D, Rosse, W, Phillips, G, Peace, D, Johnson-Telfair, A, Milner, P, Kutlar, A, Tracy, A, Ballas, SK, Allen, GE, Moshang, J, Scott, B, Steinberg, M, Anderson, A, Sabahi, V, Pegelow, C, Temple, D, Case, E, Harrell, R, Childerie, S, Embury, S, Schmidt, B, Davies, D, Koshy, M, Talischy-Zahed, N, Dorn, L, Pendarvis, G, McGee, M, Telfer, M, Davis, A, Castro, O, Finke, H, Perlin, E, Siteman, J, Gascon, P, Di Paolo, P, Gargiulo, S, Eckman, J, Bailey, JH, Platt, A, Waller, L, Ramirez, G, Knors, V, Hernandez, S, Rodriguez, EM, Wilkes, E, Vichinsky, E, Claster, S, Earles, A, Kleman, K, McLaughlin, K, Swerdlow, P, Smith, W, Maddox, B, Usry, L, Brenner, A, Williams, K, O'Brien, R, Genther, K, Shurin, S, Berman, B, Chiarucci, K, Keverline, L, Olivieri, N, Shaw, D, Lewis, N, Bridges, K, Tynan, B, Winograd, C, Bellevue, R, Dosik, H, Sheikhai, M, Ryans, P, Souffrant, H, Prchal, J, Braddock, J, McArdle, T, Carlos, T, Schmotzer, A, Gardner, D, Dover, G, Bergner, M, Ewart, C, Eckert, S, Lent, C, Ullrich, J, Fishpaw, L, Tirado, G, Gibson, J, Moeller, T, Nagle, T & Luthra, P 2000, 'Cost-effectiveness of hydroxyurea in sickle cell anemia', American Journal of Hematology, vol. 64, no. 1, pp. 26-31. https://doi.org/10.1002/(SICI)1096-8652(200005)64:1<26::AID-AJH5>3.0.CO;2-F
Moore, Richard D. ; Charache, Samuel ; Terrin, Michael L. ; Barton, Franca B. ; Ballas, Samir K. ; Orringer, E. ; Jones, S. ; Strayhorn, D. ; Rosse, W. ; Phillips, G. ; Peace, D. ; Johnson-Telfair, A. ; Milner, P. ; Kutlar, A. ; Tracy, A. ; Ballas, S. K. ; Allen, G. E. ; Moshang, J. ; Scott, B. ; Steinberg, M. ; Anderson, A. ; Sabahi, V. ; Pegelow, C. ; Temple, D. ; Case, E. ; Harrell, R. ; Childerie, S. ; Embury, S. ; Schmidt, B. ; Davies, D. ; Koshy, M. ; Talischy-Zahed, N. ; Dorn, L. ; Pendarvis, G. ; McGee, M. ; Telfer, M. ; Davis, A. ; Castro, O. ; Finke, H. ; Perlin, E. ; Siteman, J. ; Gascon, P. ; Di Paolo, P. ; Gargiulo, S. ; Eckman, J. ; Bailey, J. H. ; Platt, A. ; Waller, L. ; Ramirez, G. ; Knors, V. ; Hernandez, S. ; Rodriguez, E. M. ; Wilkes, E. ; Vichinsky, E. ; Claster, S. ; Earles, A. ; Kleman, K. ; McLaughlin, K. ; Swerdlow, P. ; Smith, W. ; Maddox, B. ; Usry, L. ; Brenner, A. ; Williams, K. ; O'Brien, R. ; Genther, K. ; Shurin, S. ; Berman, B. ; Chiarucci, K. ; Keverline, L. ; Olivieri, N. ; Shaw, D. ; Lewis, N. ; Bridges, K. ; Tynan, B. ; Winograd, C. ; Bellevue, R. ; Dosik, H. ; Sheikhai, M. ; Ryans, P. ; Souffrant, H. ; Prchal, J. ; Braddock, J. ; McArdle, T. ; Carlos, T. ; Schmotzer, A. ; Gardner, D. ; Dover, G. ; Bergner, M. ; Ewart, C. ; Eckert, S. ; Lent, C. ; Ullrich, J. ; Fishpaw, L. ; Tirado, G. ; Gibson, J. ; Moeller, T. ; Nagle, T. ; Luthra, P. / Cost-effectiveness of hydroxyurea in sickle cell anemia. In: American Journal of Hematology. 2000 ; Vol. 64, No. 1. pp. 26-31.
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TY - JOUR

T1 - Cost-effectiveness of hydroxyurea in sickle cell anemia

AU - Moore, Richard D.

AU - Charache, Samuel

AU - Terrin, Michael L.

AU - Barton, Franca B.

AU - Ballas, Samir K.

AU - Orringer, E.

AU - Jones, S.

AU - Strayhorn, D.

AU - Rosse, W.

AU - Phillips, G.

AU - Peace, D.

AU - Johnson-Telfair, A.

AU - Milner, P.

AU - Kutlar, A.

AU - Tracy, A.

AU - Ballas, S. K.

AU - Allen, G. E.

AU - Moshang, J.

AU - Scott, B.

AU - Steinberg, M.

AU - Anderson, A.

AU - Sabahi, V.

AU - Pegelow, C.

AU - Temple, D.

AU - Case, E.

AU - Harrell, R.

AU - Childerie, S.

AU - Embury, S.

AU - Schmidt, B.

AU - Davies, D.

AU - Koshy, M.

AU - Talischy-Zahed, N.

AU - Dorn, L.

AU - Pendarvis, G.

AU - McGee, M.

AU - Telfer, M.

AU - Davis, A.

AU - Castro, O.

AU - Finke, H.

AU - Perlin, E.

AU - Siteman, J.

AU - Gascon, P.

AU - Di Paolo, P.

AU - Gargiulo, S.

AU - Eckman, J.

AU - Bailey, J. H.

AU - Platt, A.

AU - Waller, L.

AU - Ramirez, G.

AU - Knors, V.

AU - Hernandez, S.

AU - Rodriguez, E. M.

AU - Wilkes, E.

AU - Vichinsky, E.

AU - Claster, S.

AU - Earles, A.

AU - Kleman, K.

AU - McLaughlin, K.

AU - Swerdlow, P.

AU - Smith, W.

AU - Maddox, B.

AU - Usry, L.

AU - Brenner, A.

AU - Williams, K.

AU - O'Brien, R.

AU - Genther, K.

AU - Shurin, S.

AU - Berman, B.

AU - Chiarucci, K.

AU - Keverline, L.

AU - Olivieri, N.

AU - Shaw, D.

AU - Lewis, N.

AU - Bridges, K.

AU - Tynan, B.

AU - Winograd, C.

AU - Bellevue, R.

AU - Dosik, H.

AU - Sheikhai, M.

AU - Ryans, P.

AU - Souffrant, H.

AU - Prchal, J.

AU - Braddock, J.

AU - McArdle, T.

AU - Carlos, T.

AU - Schmotzer, A.

AU - Gardner, D.

AU - Dover, G.

AU - Bergner, M.

AU - Ewart, C.

AU - Eckert, S.

AU - Lent, C.

AU - Ullrich, J.

AU - Fishpaw, L.

AU - Tirado, G.

AU - Gibson, J.

AU - Moeller, T.

AU - Nagle, T.

AU - Luthra, P.

PY - 2000/5/9

Y1 - 2000/5/9

N2 - The Multicenter Study of Hydroxyurea in Sickle Cell Anemia (MSH) demonstrated the efficacy of hydroxyurea in reducing the rate of painful crises compared to placebo. We used resource utilization data collected in the MSH to determine the cost-effectiveness of hydroxyurea. The MSH was a randomized, placebo-controlled double-blind clinical trial involving 299 patients at 21 sites. The primary outcome, visit to a medical facility, was one of the criteria to define occurrence of painful crisis. Cost estimates were applied to all outpatient and emergency department visits and inpatient hospital stays that were classified as a crisis. Other resources for which cost estimates were applied included hospitalization for chest syndrome, analgesics received, hydroxyurea dosing, laboratory testing, end clinic visits for management of patient care. Annualized differential costs were calculated between hydroxyurea- and placebo-receiving patients. Hospitalization for painful crisis accounted for the majority of costs in both arms of the study, with an annual mean of $12,160 (95% CI: $9,440, $14,880) for hydroxyurea and $17,290 (95% CI: $13,010, $21,570) for placebo. The difference in means was $5,130 (95% CI: $60, $10,200; P = 0.048). Chest syndrome was the next largest cost with a mean difference of $830 (95% CI: $- 340, $2,000; P = 0.16). The hydroxyurea arm was also associated with lower costs for emergency department visits, transfusion, and use of opiate analgesics, in total, the annual average cost per patient receiving hydroxyurea was $16,810 (95% CI: $13,350, $20,270) and the annual average costs per patient receiving placebo was $22,020 (95% CI: $17,340, $26,710). The difference in means was $45,210 (95% CI: $-810, $11,030; P = 0.21). The cost of hydroxyurea with the more intensive monitoring required when using this drug appears to be more than offset by decreased costs for medical care of painful crisis and analgesic use. Although the total cost difference was not significant statistically, these results suggest that hydroxyurea therapy is cost-effective compared to placebo in the management of adult patients with sickle cell anemia. If hydroxyurea can prevent development of chronic organ damage, long-term savings may be even greater. (C) Wiley-Liss, Inc.

AB - The Multicenter Study of Hydroxyurea in Sickle Cell Anemia (MSH) demonstrated the efficacy of hydroxyurea in reducing the rate of painful crises compared to placebo. We used resource utilization data collected in the MSH to determine the cost-effectiveness of hydroxyurea. The MSH was a randomized, placebo-controlled double-blind clinical trial involving 299 patients at 21 sites. The primary outcome, visit to a medical facility, was one of the criteria to define occurrence of painful crisis. Cost estimates were applied to all outpatient and emergency department visits and inpatient hospital stays that were classified as a crisis. Other resources for which cost estimates were applied included hospitalization for chest syndrome, analgesics received, hydroxyurea dosing, laboratory testing, end clinic visits for management of patient care. Annualized differential costs were calculated between hydroxyurea- and placebo-receiving patients. Hospitalization for painful crisis accounted for the majority of costs in both arms of the study, with an annual mean of $12,160 (95% CI: $9,440, $14,880) for hydroxyurea and $17,290 (95% CI: $13,010, $21,570) for placebo. The difference in means was $5,130 (95% CI: $60, $10,200; P = 0.048). Chest syndrome was the next largest cost with a mean difference of $830 (95% CI: $- 340, $2,000; P = 0.16). The hydroxyurea arm was also associated with lower costs for emergency department visits, transfusion, and use of opiate analgesics, in total, the annual average cost per patient receiving hydroxyurea was $16,810 (95% CI: $13,350, $20,270) and the annual average costs per patient receiving placebo was $22,020 (95% CI: $17,340, $26,710). The difference in means was $45,210 (95% CI: $-810, $11,030; P = 0.21). The cost of hydroxyurea with the more intensive monitoring required when using this drug appears to be more than offset by decreased costs for medical care of painful crisis and analgesic use. Although the total cost difference was not significant statistically, these results suggest that hydroxyurea therapy is cost-effective compared to placebo in the management of adult patients with sickle cell anemia. If hydroxyurea can prevent development of chronic organ damage, long-term savings may be even greater. (C) Wiley-Liss, Inc.

KW - Cost-effectiveness

KW - Hydroxyurea

KW - Medical care costs

KW - Sickle cell anemia

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U2 - 10.1002/(SICI)1096-8652(200005)64:1<26::AID-AJH5>3.0.CO;2-F

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