Characterization of opioid use in sickle cell disease

Han, Jin; Zhou, Jifang; Saraf, Santosh L.; Calip, Gregory S.

doi:10.1002/pds.4291

Cited by 43 publications

(44 citation statements)

References 44 publications

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“…The differences in hydroxyurea and opioid prescribing for children and adults with SCD may be due to additional factors, including physician concerns surrounding reported lower increases in fetal hemoglobin levels in adults than children after hydroxyurea therapy, patient noncompliance with hydroxyurea therapy and laboratory monitoring, and natural progression of chronic pain in adults due to vaso‐occlusive complications …”

Section: Discussionmentioning

confidence: 93%

National trends in hydroxyurea and opioid prescribing for sickle cell disease by office‐based physicians in the United States, 1997‐2017

Segal

Lanzkron

et al. 2019

Pharmacoepidemiology and Drug

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Purpose To identify trends in physician drug prescribing practices for sickle cell disease (SCD). Methods We used data from the National Disease and Therapeutic Index to evaluate medications prescribed to children (definition: aged 19 years or younger) and adults (20 years or older) with SCD by office‐based physicians in the United States during 1997 to 2017. Prescriptions were evaluated in 3‐year intervals. Results The proportion of SCD visits that included new/continued hydroxyurea prescriptions increased from less than or equal to 8% before 2009 to 33% in 2015 to 2017. The increase was significant in visits by children (2.5% in 1997‐1999 to 47% in 2015‐2017; P = .003 by Spearman's rank‐order correlation) but not in adults (6.9% to 11%; P = .12). Opioids, started/continued in 13% (lowest 3‐year average) to 35% (highest) of visits by children and 55% to 81% of visits by adults, remained the most frequently prescribed medications for SCD overall. There were no significant changes over time in opioid prescribing for adults (P = .64) or children (P = .38). Hematologists/oncologists accounted for a higher proportion of visits by children (67.2% over 1997‐2017) than adults (25.2%), while emergency medicine visits were higher in adults (14.0%) than children (2.6%). Conclusions This study suggests a robust increase in hydroxyurea prescribing for children with SCD. The BABY HUG trial, which demonstrated safety and efficacy of starting hydroxyurea in infancy and informed current SCD guidelines recommending broader use in children, may have contributed to this increase. However, hydroxyurea prescribing for adults remains infrequent and considerably lower than opioids. Barriers in access to specialist care persist for adults with SCD.

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Section: Discussionmentioning

confidence: 93%

National trends in hydroxyurea and opioid prescribing for sickle cell disease by office‐based physicians in the United States, 1997‐2017

Segal

Lanzkron

et al. 2019

Pharmacoepidemiology and Drug

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“…Erythrocyte transfusion events were identified using relevant ICD‐9‐CM diagnosis codes in addition to common procedure coding system codes documented among the administrative health insurance claims. Information on opioid medication doses was determined using pharmacy dispensing records and doses were converted to cumulative oral morphine equivalent (OME) using methods described previously (Han et al , , ).…”

Section: Methodsmentioning

confidence: 99%

Hydroxycarbamide adherence and cumulative dose associated with hospital readmission in sickle cell disease: a 6‐year population‐based cohort study

et al. 2018

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Sickle cell disease (SCD) is a congenital haemoglobinopathy that causes frequent acute care/emergency room visits and hospital admissions for affected individuals. Evidence from population-based studies demonstrating the role of hydroxycarbamide (HC, also termed hydroxyurea) in reducing hospital readmission rates is limited. Our objective was to describe the use of HC and its association with acute care utilization and readmission rates using a large, nationally-representative US health insurance claims database over a 6-year period between 2009 and 2014. We identified 20 721 SCD-related inpatient and acute care encounters. Patients had been exposed to HC within 6 months prior to admission in 4263 (21%) of SCD-related admission events. HC use was more common among children aged 10-17 years and young adults aged 18-29 years. HC was associated with lower 30-day all-cause readmission rates in adults treated with average daily doses ≥1 g (odds ratio [OR], 0·72, 95% confidence interval [CI] 0·52-0·99) and doses of 0·5-1 g (OR, 0·73, 95% CI 0·57-0·93), compared to HC treatment with average daily doses of <0·5 g; adherence to HC with proportion of days covered of ≥0·80 was also associated with significantly lower 30-day all-cause readmission risks (OR, 0·59, 95% CI 0·41-0·84). Optimal therapeutic dosing and adherence to HC treatment significantly reduces 30-day readmissions among patients with SCD.

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“…Paulukonis et al proposed the combination of an ICD-9-CM code for SCD in at least two healthcare encounters, independent of setting, and at least one code for an associated treatment, procedure, or complication of SCD, 54 an approach recently adapted by other researchers. 55,56 However, Snyder et al reported that algorithm had a false-negative rate (1 minus sensitivity) of 14.2%, compared with 4.0% for one requiring 3 diagnostic claims. 23…”

Section: Combinations Of Diagnosis Codes With Scd-associated Treatmenmentioning

confidence: 99%

Administrative data identify sickle cell disease: A critical review of approaches in U.S. health services research

Grosse

Green

Reeves

2020

Pediatric Blood & Cancer

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To identify people living with sickle cell disease (SCD) and study their healthcare utilization, researchers can either use clinical records linked to administrative data or use billing diagnosis codes in stand-alone administrative databases. Correct identification of individuals clinically managed for SCD using diagnosis codes in claims databases is limited by the accuracy of billing codes in outpatient encounters. In this critical review, we assess the strengths and limitations of claims-based SCD case-finding algorithms in stand-alone administrative databases that contain both inpatient and outpatient records. Validation studies conducted using clinical records and newborn screening for confirmation of SCD case status have found that algorithms that require three or more nonpharmacy claims or one inpatient claim plus two or more outpatient claims with SCD codes show acceptable accuracy (positive predictive value and sensitivity) in children and adolescents. Future studies might seek to assess the accuracy of case-finding algorithms over the lifespan.

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Characterization of opioid use in sickle cell disease

Abstract: Our study showed that only 40% SCD patients were on opioid analgesics during a 12-month span. However, a non-trivial number of patients used a much higher dose of opioids despite a relatively low average daily opioid dose among SCD patients, particularly with vaso-occlusive complications.

Cited by 43 publications

References 44 publications

National trends in hydroxyurea and opioid prescribing for sickle cell disease by office‐based physicians in the United States, 1997‐2017

National trends in hydroxyurea and opioid prescribing for sickle cell disease by office‐based physicians in the United States, 1997‐2017

Hydroxycarbamide adherence and cumulative dose associated with hospital readmission in sickle cell disease: a 6‐year population‐based cohort study

Administrative data identify sickle cell disease: A critical review of approaches in U.S. health services research

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