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Public Health Impact of Complete and Incomplete Rotavirus Vaccination among Commercially and Medicaid Insured Children in the United States

BACKGROUND: This study (NCT01682005) aims to assess clinical and cost impacts of complete and incomplete rotavirus (RV) vaccination. METHODS: Beneficiaries who continuously received medical and pharmacy benefits since birth were identified separately in Truven Commercial Claims and Encounters (2000–...

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Detalles Bibliográficos
Autores principales: Krishnarajah, Girishanthy, Duh, Mei Sheng, Korves, Caroline, Demissie, Kitaw
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709043/
https://www.ncbi.nlm.nih.gov/pubmed/26751375
http://dx.doi.org/10.1371/journal.pone.0145977
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author Krishnarajah, Girishanthy
Duh, Mei Sheng
Korves, Caroline
Demissie, Kitaw
author_facet Krishnarajah, Girishanthy
Duh, Mei Sheng
Korves, Caroline
Demissie, Kitaw
author_sort Krishnarajah, Girishanthy
collection PubMed
description BACKGROUND: This study (NCT01682005) aims to assess clinical and cost impacts of complete and incomplete rotavirus (RV) vaccination. METHODS: Beneficiaries who continuously received medical and pharmacy benefits since birth were identified separately in Truven Commercial Claims and Encounters (2000–2011) and Truven Medicaid Claims (2002–2010) and observed until the first of end of insurance eligibility or five years. Infants with ≥1 RV vaccine within the vaccination window (6 weeks-8 months) were divided into completely and incompletely vaccinated cohorts. Historically unvaccinated (before 2007) and contemporarily unvaccinated (2007 and after) cohorts included children without RV vaccine. Claims with International Classification of Disease 9(th) edition (ICD-9) codes for diarrhea and RV were identified. First RV episode incidence, RV-related and diarrhea-related healthcare resource utilization after 8 months old were calculated and compared across groups. Poisson regressions were used to generate incidence rates with 95% confidence intervals (CIs). Mean total, inpatient, outpatient and emergency room costs for first RV and diarrhea episodes were calculated; bootstrapping was used to construct 95% CIs to evaluate cost differences. RESULTS: 1,069,485 Commercial and 515,557 Medicaid patients met inclusion criteria. Among commercially insured, RV incidence per 10,000 person-years was 3.3 (95% CI 2.8–3.9) for completely, 4.0 (95% CI 3.3–5.0) for incompletely vaccinated, and 20.9 (95% CI 19.5–22.4) for contemporarily and 40.3 (95% CI 38.6–42.1) for historically unvaccinated. Rates in Medicaid were 7.5 (95% CI 4.8–11.8) for completely, 9.0 (95% CI 6.5–12.3) for incompletely vaccinated, and 14.6 (95% CI 12.8–16.7) for contemporarily and 52.0 (95% CI 50.2–53.8) for historically unvaccinated. Mean cost for first RV episode per cohort member was $15.33 (95% CI $12.99-$18.03) and $4.26 ($95% CI $2.34-$6.35) lower for completely vaccinated versus contemporarily unvaccinated in Commercial and Medicaid, respectively. CONCLUSIONS: RV vaccination results in significant reduction in RV infection. There is evidence of indirect benefit to unvaccinated individuals.
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spelling pubmed-47090432016-01-15 Public Health Impact of Complete and Incomplete Rotavirus Vaccination among Commercially and Medicaid Insured Children in the United States Krishnarajah, Girishanthy Duh, Mei Sheng Korves, Caroline Demissie, Kitaw PLoS One Research Article BACKGROUND: This study (NCT01682005) aims to assess clinical and cost impacts of complete and incomplete rotavirus (RV) vaccination. METHODS: Beneficiaries who continuously received medical and pharmacy benefits since birth were identified separately in Truven Commercial Claims and Encounters (2000–2011) and Truven Medicaid Claims (2002–2010) and observed until the first of end of insurance eligibility or five years. Infants with ≥1 RV vaccine within the vaccination window (6 weeks-8 months) were divided into completely and incompletely vaccinated cohorts. Historically unvaccinated (before 2007) and contemporarily unvaccinated (2007 and after) cohorts included children without RV vaccine. Claims with International Classification of Disease 9(th) edition (ICD-9) codes for diarrhea and RV were identified. First RV episode incidence, RV-related and diarrhea-related healthcare resource utilization after 8 months old were calculated and compared across groups. Poisson regressions were used to generate incidence rates with 95% confidence intervals (CIs). Mean total, inpatient, outpatient and emergency room costs for first RV and diarrhea episodes were calculated; bootstrapping was used to construct 95% CIs to evaluate cost differences. RESULTS: 1,069,485 Commercial and 515,557 Medicaid patients met inclusion criteria. Among commercially insured, RV incidence per 10,000 person-years was 3.3 (95% CI 2.8–3.9) for completely, 4.0 (95% CI 3.3–5.0) for incompletely vaccinated, and 20.9 (95% CI 19.5–22.4) for contemporarily and 40.3 (95% CI 38.6–42.1) for historically unvaccinated. Rates in Medicaid were 7.5 (95% CI 4.8–11.8) for completely, 9.0 (95% CI 6.5–12.3) for incompletely vaccinated, and 14.6 (95% CI 12.8–16.7) for contemporarily and 52.0 (95% CI 50.2–53.8) for historically unvaccinated. Mean cost for first RV episode per cohort member was $15.33 (95% CI $12.99-$18.03) and $4.26 ($95% CI $2.34-$6.35) lower for completely vaccinated versus contemporarily unvaccinated in Commercial and Medicaid, respectively. CONCLUSIONS: RV vaccination results in significant reduction in RV infection. There is evidence of indirect benefit to unvaccinated individuals. Public Library of Science 2016-01-11 /pmc/articles/PMC4709043/ /pubmed/26751375 http://dx.doi.org/10.1371/journal.pone.0145977 Text en © 2016 Krishnarajah et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Krishnarajah, Girishanthy
Duh, Mei Sheng
Korves, Caroline
Demissie, Kitaw
Public Health Impact of Complete and Incomplete Rotavirus Vaccination among Commercially and Medicaid Insured Children in the United States
title Public Health Impact of Complete and Incomplete Rotavirus Vaccination among Commercially and Medicaid Insured Children in the United States
title_full Public Health Impact of Complete and Incomplete Rotavirus Vaccination among Commercially and Medicaid Insured Children in the United States
title_fullStr Public Health Impact of Complete and Incomplete Rotavirus Vaccination among Commercially and Medicaid Insured Children in the United States
title_full_unstemmed Public Health Impact of Complete and Incomplete Rotavirus Vaccination among Commercially and Medicaid Insured Children in the United States
title_short Public Health Impact of Complete and Incomplete Rotavirus Vaccination among Commercially and Medicaid Insured Children in the United States
title_sort public health impact of complete and incomplete rotavirus vaccination among commercially and medicaid insured children in the united states
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4709043/
https://www.ncbi.nlm.nih.gov/pubmed/26751375
http://dx.doi.org/10.1371/journal.pone.0145977
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