Hydroxyurea in children with sickle cell disease: Practice patterns and barriers to utilization

Abstract

Hydroxyurea (HU) is underutilized in adults with sickle cell disease (SCD) despite the Multicenter Study of Hydroxyurea in Sickle Cell Anemia (MSH) (1). Since little is known about HU utilization in children with SCD we sought to: 1) evaluate patterns of HU utilization; 2) elicit how providers define frequent pain when prescribing HU; and 3) identify barriers to HU use by surveying members of the American Society of Pediatric Hematology/Oncology. Data analysis included descriptive statistics and Chi-square. Of the 350 respondents, 63% care for SCD patients. Of these providers, only 9% have 50–90% of patients on HU, while 10% have 30% of patients on HU (35.2% vs. 20%; p=0.023; Chi-square). Provider-related barriers to prescribing HU included compliance with: HU (86%), laboratory monitoring (85%), and contraception (85%). Our survey suggests substantial variation in HU utilization in children. Providers accounting for pain managed both in and out of the hospital had more patients on HU. Existing barriers to HU utilization should be addressed to optimize care for children with SCD.