The recommendation from the 2014 National Heart, Lung, and Blood Institute guidelines 1 to treat all adults with sickle cell anemia (SCA) and 3 or more moderate to severe pain crises within 1 year with hydroxyurea was rated as strong based on high-quality evidence reviewed in 2008. 2,3 Despite benefits in reducing pain crises, hospitalizations, blood transfusions, and possibly mortality, it is thought that hydroxyurea is underused, although the extent of its use is unknown. 2 We sought to document the use of hydroxyurea when indicated for SCA in a large insurance claims database. a Data are expressed as No. (%) [95% CI] unless otherwise indicated.

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