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Kurosky SK, Esterberg E, Irwin DE, Trantham L, Packnett E, Novy P, Whelan J, Hogea C. Meningococcal Vaccination Among Adolescents in the United States: A Tale of Two Age Platforms. J Adolesc Health 2019; 65:107-115. [PMID: 31103378 DOI: 10.1016/j.jadohealth.2019.02.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/04/2019] [Accepted: 02/13/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Despite recommended routine vaccination with meningococcal conjugate vaccine (MenACWY) at ages 11-12 years with a booster at age 16 years, national estimates indicate MenACWY uptake is lower in older adolescents than younger adolescents. This study aimed to identify factors associated with MenACWY uptake among adolescents. METHODS Commercial Claims and Encounters (CCAE) and Medicaid MarketScan Databases from 2011 to 2016 were retrospectively analyzed (2017) to determine receipt of ≥1 dose of MenACWY during early (10.5 through 13 years) and late (15.5 through 18 years) adolescence. Multivariable logistic regression and nonlinear decomposition analyses were used to identify factors associated with MenACWY vaccination, potential missed opportunities, and differences between age groups. RESULTS A larger proportion of younger adolescents than older adolescents received MenACWY: CCAE, 71.7% versus 48.9% (p < .001); Medicaid, 59.3% versus 31.8% (p < .001), respectively. In multivariable models (CCAE), older adolescents were less likely than younger ones to receive MenACWY (adjusted odds ratios [95% confidence intervals]: .68 [.67, .69]) and more likely to have a potential missed opportunity (1.27 [1.25, 1.28]). Decomposition results showed lower MenACWY uptake in older adolescents is largely attributed to fewer non-MenACWY vaccines received, fewer preventive care visits, and interaction with nonpediatric healthcare providers. DISCUSSION Missed opportunities and infrequent preventive care encounters contribute to lack of vaccination in younger and older adolescents. However, the disparity in uptake between the two age groups was largely attributable to differences in healthcare utilization, suggesting a need for unique strategies to increase uptake among older adolescents, such as solidifying a vaccination platform for ages 16-18 years through encouragement of annual preventive care visits.
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Affiliation(s)
- Samantha K Kurosky
- RTI Health Solutions, Health Economics, Research Triangle Park, North Carolina.
| | - Elizabeth Esterberg
- RTI Health Solutions, Health Economics, Research Triangle Park, North Carolina
| | - Debra E Irwin
- Truven Health Analytics LLC, an IBM Watson Health Company, Outcomes Research Department, Durham, North Carolina
| | - Laurel Trantham
- RTI Health Solutions, Health Economics, Research Triangle Park, North Carolina
| | - Elizabeth Packnett
- Truven Health Analytics LLC, an IBM Watson Health Company, Outcomes Research Department, Durham, North Carolina
| | - Patricia Novy
- GSK, U.S. Medical Affairs, Philadelphia, Pennsylvania
| | - Jane Whelan
- GSK, Clinical and Epidemiology, Vaccines, Amsterdam, The Netherlands
| | - Cosmina Hogea
- GSK, U.S. Health Outcomes & Epidemiology - Vaccines, Philadelphia, Pennsylvania
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Trantham L, Sikirica MV, Candrilli SD, Benson VS, Mohan D, Neil D, Joshi AV. Healthcare costs and utilization associated with muscle weakness diagnosis codes in patients with chronic obstructive pulmonary disease: a United States claims analysis. J Med Econ 2019; 22:319-327. [PMID: 30580639 DOI: 10.1080/13696998.2018.1563414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
AIMS Muscle weakness (MW)-attributable healthcare resource utilization (HCRU) and costs in patients with chronic obstructive pulmonary disease (COPD) have not been well-characterized in US insurance claims databases. The primary objective of this study was to estimate HCRU in patients with evidence of COPD with and without MW diagnosis codes. MATERIALS AND METHODS This retrospective analysis used the MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases. Between January 2007 and March 2016, we identified patients aged ≥40 years with diagnosis codes for COPD (≥1 emergency department or inpatient claim or ≥2 outpatient claims within 1 year). The cohort was divided into patients with and without ≥1 MW diagnosis code. Propensity score matching was used to generate pairs of patients with and without MW (1:1). Multivariable regression analyses were used to estimate adjusted incremental costs and utilization attributable to the presence of MW diagnosis codes among patients with COPD. RESULTS Of 427,131 patients who met the study inclusion criteria, 14% had evidence of MW. After matching, 107,420 unique patients remained equally distributed across MW status. Patients with MW diagnosis codes had greater predicted annual HCRU, $2,465 greater total predicted annual COPD-related costs, and $15,179 greater total all-cause costs than those without MW diagnosis codes. Overall, <1% of patients received COPD-related pulmonary rehabilitation services. LIMITATIONS Study limitations include the potential for undercoding of MW and lack of information on severity of MW in claims data. CONCLUSION The presence of MW diagnosis codes yielded higher HCRU in this COPD population and suggests that the burden of MW affects both all-cause and COPD-related care. However, utilization of pulmonary rehabilitation, a known effective treatment for MW, remains low. Future research should expand on our results by assessing data sources that allow for clinical confirmation of MW among patients with COPD.
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Affiliation(s)
- Laurel Trantham
- a Health Economics, RTI Health Solutions , Research Triangle Park , NC , USA
| | - Mirko V Sikirica
- b Value Evidence and Outcomes , GlaxoSmithKline , Collegeville , PA , USA
| | - Sean D Candrilli
- a Health Economics, RTI Health Solutions , Research Triangle Park , NC , USA
| | - Victoria S Benson
- c Real World Evidence and Epidemiology, GlaxoSmithKline , West Drayton , Uxbridge , UK
| | - Divya Mohan
- d Research and Development, GlaxoSmithKline , Collegeville , PA , USA
| | - David Neil
- b Value Evidence and Outcomes , GlaxoSmithKline , Collegeville , PA , USA
| | - Ashish V Joshi
- b Value Evidence and Outcomes , GlaxoSmithKline , Collegeville , PA , USA
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Trantham L, Kurosky SK, Zhang D, Johnson KD. Adherence with and completion of recommended hepatitis vaccination schedules among adults in the United States. Vaccine 2018; 36:5333-5339. [PMID: 29909136 DOI: 10.1016/j.vaccine.2018.05.111] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Adult vaccination coverage rates in the US are well below national targets, leaving many adults at increased risk. Additionally, typical vaccination coverage calculations do not adequately approximate population immunity as they do not consider whether multidose vaccines were administered within the recommended schedules. As timely administration of each dose optimizes overall vaccine effectiveness, we sought to document adherence to and completion of the hepatitis A (HepA), hepatitis B (HepB), and combined hepatitis A and hepatitis B (HepA-HepB) multidose vaccine schedule in an insured adult population in the US. METHODS We conducted a retrospective database study of administrative claims from 2008 to 2015 (analyzed in 2017). Completion of 2 (HepA) and 3 doses (HepB and HepA-HepB), and adherence to the 2- and 3-dose recommended schedules were measured among individuals aged 19 years and older at first dose. The proportion of patients who completed 2 and 3 doses and were adherent to the recommended schedule were estimated using Kaplan-Meier methods. RESULTS For HepA, 27.14% of initiating adults were adherent to the recommended schedule, and 32.05% had received a second dose by 42 months. Approximately one-third of adults who initiated the HepB or HepA-HepB series completed all 3 doses within 2 years of the minimum spacing (31.17% and 32.27%, respectively). Generally, completion and adherence were highest in individuals aged 60-64 years at the time of initiation. CONCLUSIONS Hepatitis vaccine adherence and completion in adults is suboptimal. As a result, the majority of adults initiating each series may not be receiving the full protective benefit of these multidose vaccines.
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Affiliation(s)
| | | | - Dongmu Zhang
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co, Inc., Center for Observational and Real-World Evidence (CORE), Vaccines, Kenilworth, NJ, USA
| | - Kelly D Johnson
- Merck Sharp & Dohme Corp., a subsidiary of Merck & Co, Inc., Center for Observational and Real-World Evidence (CORE), Vaccines, Kenilworth, NJ, USA
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La EM, Trantham L, Kurosky SK, Odom D, Aris E, Hogea C. An analysis of factors associated with influenza, pneumoccocal, Tdap, and herpes zoster vaccine uptake in the US adult population and corresponding inter-state variability. Hum Vaccin Immunother 2017; 14:430-441. [PMID: 29194019 PMCID: PMC5806688 DOI: 10.1080/21645515.2017.1403697] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Despite longstanding recommendations for routine vaccination against influenza; pneumococcal; tetanus, diphtheria, acellular pertussis (Tdap); and herpes zoster (HZ) among the United States general adult population, vaccine uptake remains low. Understanding factors that influence adult vaccination and coverage variability beyond the national level are important steps toward developing targeted strategies for increasing vaccination coverage. A retrospective analysis was conducted using data from the Behavioral Risk Factor Surveillance System (2011–2014). Multivariable logistic regression modeling was employed to identify individual factors associated with vaccination (socio-demographics, health status, healthcare utilization, state of residence) and generate adjusted vaccination coverage and compliance estimates nationally and by state. Results indicated that multiple characteristics were consistently associated with a higher likelihood of vaccination across all four vaccines, including female sex, increased educational attainment, and annual household income. Model-adjusted vaccination coverage estimates varied widely by state, with inter-state variability for the most recent year of data as follows: influenza (aged ≥18 years) 30.2–49.5%; pneumococcal (aged ≥65 years) 64.0–74.7%; Tdap (aged ≥18 years) 18.7–46.6%; and HZ (aged ≥60 years) 21.3–42.9%. Model-adjusted compliance with age-appropriate recommendations across vaccines was low and also varied by state: influenza+Tdap (aged 18–59 years) 7.9–24.7%; influenza+Tdap+HZ (aged 60–64 years) 4.1–14.4%; and influenza+Tdap+HZ+pneumococcal (aged ≥65 years) 3.0–18.3%. In summary, after adjusting for individual characteristics associated with vaccination, substantial heterogeneity across states remained, suggesting that other local factors (e.g. state policies) may be impacting adult vaccines uptake. Further research is needed to understand such factors, focusing on differences between states with high versus low vaccination coverage.
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Affiliation(s)
- Elizabeth M La
- a Department of Health Economics , RTI Health Solutions , Research Triangle Park, NC , USA
| | - Laurel Trantham
- a Department of Health Economics , RTI Health Solutions , Research Triangle Park, NC , USA
| | - Samantha K Kurosky
- a Department of Health Economics , RTI Health Solutions , Research Triangle Park, NC , USA
| | - Dawn Odom
- b Department of Biostatistics , RTI Health Solutions , Research Triangle Park, NC , USA
| | - Emmanuel Aris
- c Department of Real World Data and Analytics , GSK , Wavre , Belgium
| | - Cosmina Hogea
- d Department of Health Outcomes , GSK , Philadelphia , PA , USA
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Harbeck N, De Laurentiis M, Mitra D, Trantham L, Di Virgilio R, De Placido S. Preliminary Data from a Prospective Non-interventional Study to Characterize Real-World Treatment Patterns and Outcomes of Women with ER+/HER2-Advanced/Metastatic Breast Cancer. Breast 2017. [DOI: 10.1016/s0960-9776(17)30695-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Gillen E, Lich KH, Trantham L, Silberman P, Weinberger M, Holmes M. Plan Selection in the Non-Group Market in the First Year of the Health Insurance Marketplace. N C Med J 2017; 78:77-83. [PMID: 28420765 DOI: 10.18043/ncm.78.2.77] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Affordable Care Act (ACA)-created Marketplaces reduced barriers to entry in the non-group health insurance market. Although tax credits were available to individuals who enrolled in qualified health plans (QHPs) beginning in 2014, many individuals chose not to switch plans. We examined characteristics associated with switching from a non-ACA compliant plan to a QHP in 2014 and, conditional on switching, the characteristics associated with selection of a specific plan level.METHODS Using claims data from a large commercial insurer, we examined characteristics associated with switching to a QHP in 2014. For those who did switch, we used a multinomial logit model to estimate odds of selecting different metal levels-representing varying degrees of coverage-for a group of the highest and lowest risk individuals.RESULTS We found individuals most likely to benefit from the premium and benefit requirements on QHPs were more likely to switch to QHPs. Individuals at high-risk for high health care expenditures who had advance premium tax credits (APTCs) had lower odds of choosing a less generous plan compared to individuals without APTCs (odds of bronze plan over silver: 0.40, CI: 0.30 - 0.55), while individuals at low-risk of being high cost with APTCs were more likely to select a plan with a lower premium (odds bronze plan over silver: 1.35, CI: 1.09 - 1.66).LIMITATIONS This study was conducted with data from 1 health plan, limiting its national generalizability; however, this study is a good representation of activity within the state.CONCLUSIONS APTCs are important for ensuring that less healthy individuals are able to afford adequate levels of coverage.
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Affiliation(s)
- Emily Gillen
- research economist, RTI International, Research Triangle Park, North Carolina
| | - Kristen Hassmiller Lich
- assistant professor, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, North Carolina
| | - Laurel Trantham
- senior health outcomes scientist, Health Economics, RTI Health Solutions, Research Triangle Park, North Carolina
| | - Pam Silberman
- professor, director, Executive Doctoral Program in Health Leadership, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, North Carolina
| | - Morris Weinberger
- chair, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Policy and Management, Chapel Hill, North Carolina
| | - Mark Holmes
- associate professor, director, Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina
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Trantham L, Kurosky S, Zhang D, Johnson K. Adherence to Multi-Dose Hepatitis A and Hepatitis B Vaccine Schedules in the United States. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.1347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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