Patterns of hormonal contraception use in women with sickle cell disease and employer-sponsored insurance

OBJECTIVE: While an improved understanding of the epidemiology and outcomes of hormonal contraceptive use in persons with sickle cell disease is needed to better inform evidence-based guidelines, patterns of contraception use remain understudied. Our objective was to examine patterns of contraception use among patients with sickle cell disease and employer-sponsored insurance. STUDY DESIGN: Our analyses utilized the Merative™ MarketScan® Commercial Database (2012-2019). The study included females 12-44 years meeting the study definition of sickle cell disease (presence of three ICD-9 or ICD-10 codes consistent with sickle cell disease). We utilized pharmacy and procedure claims to capture hormonal contraception use. RESULTS: We identified 5957 unique females of reproductive age (12-44 years) with sickle cell disease, 1653 (28%) of whom utilized hormonal contraception. When examining the first identified contraception prescription, 43.9% were prescribed estrogen-containing agents and 56.1% were prescribed progestin-only. The most frequently prescribed contraceptive was combined contraceptive pills (n = 645, 39%), followed by depot medroxyprogesterone acetate (n = 413, 25%). Intrauterine devices and subcutaneous implants were prescribed to 15.7% and 6.4% of individuals, respectively. CONCLUSIONS: Our work identified hormonal contraception use in less than one-third of reproductive-age females with sickle cell disease using employer-sponsored insurance. Over 40% of new users of hormonal contraception received prescriptions for estrogen-containing agents, demonstrating a need for education regarding the 2024 U.S. MEC recommendations, which contradict estrogen for patients with sickle cell disease. Future directions should also include understanding patient characteristics and health outcomes among combined hormonal contraceptive users with sickle cell disease to better inform eligibility criteria. IMPLICATIONS: Estrogen-containing agents make up a substantial percentage of contraception prescriptions in women with sickle cell disease and employer-sponsored insurance. High-quality data regarding the safety of hormonal contraception in the setting of sickle cell disease are needed to inform evidence-based guidelines and medical eligibility criteria.