Aim To study the effectiveness of hydroxyurea in reducing the number of inpatient admissions due to vaso-occlusive crisis in children with sickle cell disease and estimation of potential cost savings for the NHS.
Methods Retrospective audit of number of admissions, length of stay, use of intravenous opioids over a period of 2 years before and after starting hydroxyurea treatment in 5 children with sickle cell disease.
Results Of 5 patients with sickle cell disease 3 with HbSS and 2 with HbSC were started on hydroxyurea over the last 5 year period. Comparison was made between the numbers, severity and duration of the vaso-occlusive episodes needing inpatient admission before and during treatment are made and potential cost savings for the NHS estimated.
After starting treatment with hydroxyurea there was a reduction in the number of inpatient admission by 38% (50 vs 31) and inpatient days by 43%(184 Vs 105). A reduction in proportion of admissions needing iv opioids (20% Vs 12.9%) as well as in the number of inpatient days on iv opioids (29 days vs 9 days, reduction by 69%). In one patient the treatment was stopped after 11 months due to poor compliance with blood tests. All patients showed decrease in the number of admissions and opioid use except for one patient in whom there was an apparent increase in both. The diagnosis was revised as sickle cell with fibromyalgia syndrome and hydroxyurea was later discontinued without increase in pain symptoms.
Total cost of hydroxyurea treatment over 2 year period for the 5 patients was £3602. There was a reduction in number of high dependency admission by 20 days and non-high dependency admission day by 60. The total potential cost saving from reduced admission was £73220. Net savings for the NHS estimated over the 2 years since starting hydroxyurea for the above 5 patients was £69618.
Conclusion Commencing hydroxyurea treatment after careful patient selection in sickle cell children with frequent vaso-occlusive crisis can achieve significant cost savings for the NHS while improving the quality of patient care.