Economic Burden and Clinical Effectiveness of Different Hydroxyurea Dosing Regimens in Sickle Cell Disease: Evidence from Nepal

Sickel cell disease (SCD) is a genetic potentially debilitating disease with global concern. Hydroxyurea is an oral therapeutic agent with proven laboratory and clinical efficacy for sickle cell anemia. It can be speculated that SCD tends to greatly deplete the finances of households in developing countries where there is high level of poverty and inequitable distribution of wealth and resources. To determine direct medical and non-medical cost, we conducted a study to compare standard fixed-dose hydroxyurea with dose escalation to the maximum tolerated dose. A concurrent mixed method design was conducted on patients visiting the Bheri Hospital of Nepalgunj, Nepal who came for checkup of SCD was the study population. The sociodemographic and patient-related questionnaires was utilized for the data collection. Data was analyzed using SPSS version23. Out of 80 patients, the 53.75 patients were male. The median value of Hbs was found to be 69.2. 36 patients were found to be in fixed dose group while other 48 patients fall under the dose escalated group. While observing the lab parameters hemoglobin and fetal hemoglobin is in increasing manner while other blood cell counts were decreased. More number of ADRs are observed in the fixed-dose group with vaso-oclusive pain as a major clinical complication in the people. The overall cost that a patient bear was found to be NRs. 57309.523 ± 16637.095 (i.e. around 600USD) while Nepal’s GDP per capita is around 1400 USD (based on 2023 data). The study suggests hydroxyurea dosing should be maintained properly, and evaluation of laboratory parameters and the clinical complications should be addressed properly. The economic burden seems to be high in the SCD patients. Implementing hydroxyurea, effective administration of other agents and utilizing rigorous treatment approaches have the potential to reduce the overall impact on both patients and healthcare systems.