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2.
Infect Dis Ther ; 2024 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-38507143

RESUMO

INTRODUCTION: Respiratory syncytial virus (RSV) is an important cause of lower respiratory tract disease in older adults, resulting in substantial morbidity and mortality. METHODS: This study estimates the public health impact of vaccination with the adjuvanted RSVPreF3 vaccine among adults aged ≥ 60 years in the United States (US). A static, multi-cohort Markov model was used to estimate RSV-related outcomes over a 3-year time horizon for scenarios with and without one-time RSV vaccination. The base-case analysis assumed the same vaccination coverage as for influenza vaccines, with key epidemiology and vaccine inputs obtained from the published literature and phase 3 clinical trial results for the adjuvanted RSVPreF3 vaccine. Model outcomes included the clinical burden of RSV (symptomatic RSV acute respiratory illness [RSV-ARI] cases [classified as upper or lower respiratory tract disease], pneumonia complications, and mortality) and RSV-related healthcare resource use (hospitalizations, emergency department visits, outpatient visits, and antibiotic prescriptions). RESULTS: In the base-case analysis, approximately 56.7 million adults aged ≥ 60 years received the vaccine, resulting in 2,954,465 fewer symptomatic RSV-ARI cases over 3 years compared with no vaccination, including 321,019 fewer X-ray confirmed pneumonia cases and 16,660 fewer RSV-related deaths. Vaccination also prevented a substantial number of RSV-related hospitalizations (203,891), emergency department visits (164,060), outpatient visits (1,577,586), and antibiotic prescriptions (1,343,915) over the 3-year period. A considerable public health impact was observed across a range of sensitivity analyses. CONCLUSIONS: These findings highlight the potential of the adjuvanted RSVPreF3 vaccine to substantially reduce RSV disease burden among US older adults aged ≥ 60 years.

3.
Hum Vaccin Immunother ; 20(1): 2303796, 2024 Dec 31.
Artigo em Inglês | MEDLINE | ID: mdl-38297921

RESUMO

Respiratory syncytial virus (RSV) is associated with considerable morbidity and mortality among older adults (aged ≥60 years) and adults with certain chronic conditions in the United States (US). Despite this burden, no previous studies have assessed the knowledge, attitudes, and perceptions (KAP) of RSV among these populations. This study evaluates RSV-related KAP among US adults at increased risk of severe RSV infection. A cross-sectional, web-based survey was administered from May to June 2022 to better understand respiratory infection- and RSV-related KAP among US adults who are at risk of severe RSV infection. The survey included ≥200 adults in each of 4 subgroups: adults aged 60-89 years, and adults aged 18-59 years with ≥1 chronic cardiovascular condition, chronic pulmonary condition, or diabetes mellitus. Survey responses were analyzed descriptively overall and by subgroup, with exploratory logistic regression modeling used to evaluate characteristics associated with RSV awareness and concern. Among the 827 survey respondents, only 43.3% had ever heard of RSV (n = 358/827). The study identified key knowledge gaps (e.g. bacterial vs. viral nature of respiratory infections, RSV seasonality, common RSV symptoms, extent to which RSV causes respiratory infections in specific patient populations). Although 33.7% of RSV-aware adults (n = 120/356) reported being worried/very worried about RSV, 67.3% (n = 241/358) rarely consider RSV as a potential cause of their cold/flu-like symptoms. Results from this study highlight important knowledge gaps related to RSV, perceived risk, and severity of RSV. Findings can be used to support the development of tailored education efforts to support RSV prevention.


What is the context? Respiratory syncytial virus (RSV) is a common cause of illness among older adults (60 years and older) and adults with certain chronic conditions in the United States (US), with some adults experiencing severe RSV outcomes such as hospitalization or death.Despite this considerable burden, the awareness of RSV among these at-risk populations has never been studied until now.What is new? We assessed RSV-related knowledge, attitudes, and perceptions among US adults at increased risk of severe RSV infection (adults aged 60­89 years and adults aged 18­59 years with ≥1 chronic cardiovascular condition, chronic pulmonary condition, or diabetes).Among older and at-risk adults, 43.3% had ever heard of RSV, with a lower awareness in the older adult subgroup.Among adults at increased risk of severe RSV who are aware of RSV, less than 35% consider themselves to be knowledgeable about RSV and 16­19% were unable to assess their perceived risk of contracting RSV or potential severity of RSV should they contract it.Knowledge gaps specific to RSV include the viral nature of RSV, its seasonality, symptoms, extent to which it causes respiratory infections in specific patient populations, the difficulty distinguishing RSV from other respiratory infections based on symptoms alone, and the limited testing for RSV in routine clinical practice.What is the impact? Two RSV vaccines were recently approved in the US and are recommended for the prevention of RSV among adults aged 60 years and older with shared clinical decision making.Results from this study reveal limited awareness of RSV among adults in the US at increased risk of severe RSV and knowledge gaps among those aware of RSV.These findings can be used by healthcare providers initiating shared clinical decision-making conversations with their patients aged 60 years and older who are eligible for RSV vaccination, as well as to tailor RSV disease awareness educational interventions to healthcare providers and patients.


Assuntos
Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Infecções Respiratórias , Humanos , Estados Unidos/epidemiologia , Idoso , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Estudos Transversais , Doença Crônica , Hospitalização
4.
Pharmacoecon Open ; 7(6): 975-985, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37917310

RESUMO

INTRODUCTION: Immunocompromised (IC) adults are at increased risk of developing herpes zoster (HZ) and HZ-related complications due to therapy or underlying disease. This study evaluated the cost effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in hematopoietic stem cell transplant (HSCT) recipients and other IC adults aged ≥ 18 years in the United States (US). METHODS: A static Markov model simulated cohorts of IC individuals using a 1-year cycle length and 30-year time horizon to estimate the cost effectiveness of RZV. Inputs were sourced from clinical trial results and publicly available sources/literature. Modeled populations included US adult HSCT recipients (base case), patients with human immunodeficiency virus (HIV), patients with breast cancer, patients with Hodgkin's lymphoma, and renal transplant recipients. The model reported societal costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). Sensitivity and threshold analyses were conducted. RESULTS: In the base case of 19,671 US adult HSCT recipients, RZV resulted in total societal cost savings of US$0.1 million and 109 incremental QALYs versus no vaccine. RZV was a 'dominant strategy' versus no vaccine because vaccination resulted in cost savings with QALY gains. RZV was also cost saving in renal transplant recipients, and cost effective at a willingness-to-pay threshold of US$100,000 per QALY gained in patients with HIV, breast cancer, and Hodgkin's lymphoma, with ICERs of US$33,268, US$67,682, and US$95,972 per QALY gained, respectively, versus no vaccine. CONCLUSIONS: Model results show RZV is potentially cost saving for the prevention of HZ in US adult HSCT recipients and US adults with selected immunocompromising conditions, and cost effective for others, supporting the use of RZV to prevent HZ and HZ-related complications in IC adults.

5.
Dermatol Ther (Heidelb) ; 13(11): 2649-2668, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37740149

RESUMO

INTRODUCTION: Patients with psoriasis (PsO) are at increased risk of herpes zoster (HZ), but recent data on the incidence of HZ among patients with PsO and the impact of HZ on healthcare resource use (HRU) and costs for patients with PsO have not been described. METHODS: This retrospective, longitudinal, cohort study estimated HZ incidence in cohorts of adults with vs without PsO (PsO + vs PsO-) and HRU and costs among those with PsO, with vs without HZ (PsO + /HZ + vs PsO + /HZ-) using Optum's de-identified Clinformatics Data Mart Database during 2015-2020. Patients with psoriatic arthritis were excluded from all four cohorts. Comparisons between cohorts used generalized linear models to adjust outcomes based on various baseline characteristics. RESULTS: The incidence rate of HZ was significantly higher in the PsO + (n = 144,115) vs PsO- (n = 23,837,237) cohorts at 11.35 vs 7.67 per 1000 patient-years; adjusted incidence rate ratio (aIRR): 1.21, 95% confidence interval (CI): 1.16-1.25. HRU (outpatient, emergency department, and inpatient) was significantly higher in the PsO + /HZ + (n = 1859) vs PsO + /HZ- (n = 78,664) cohorts during 1 month and 3 months after HZ diagnosis (e.g., outpatient visits during month: 2.83 vs 1.30 per patient; aIRR: 1.96; 95% CI 1.86-2.06). Mean all-cause costs were also significantly higher in the PsO + /HZ + vs PsO + /HZ- cohort during both month ($5020 vs $2715 per patient; adjusted cost difference: $1390; 95% CI $842-$1964) and 3 months ($12,305 vs $8256; adjusted cost difference: $1422; 95% CI $280-$2889) after HZ diagnosis. CONCLUSION: These findings show the increased incidence of HZ among patients with PsO and the clinical and economic burdens of HZ in this population. Considering the high prevalence of PsO, insights into the impact of HZ in these patients provide valuable evidence to inform clinical decision-making.


Psoriasis is an inflammatory condition that causes flaky, scaly skin. Herpes zoster (shingles) causes a painful rash, usually on the abdomen. However, recent data on the proportion of patients with psoriasis who develop herpes zoster is lacking. Furthermore, little is known about the healthcare resources that are used or the costs of care for patients with psoriasis who develop herpes zoster. We found that patients with psoriasis were 21% more likely to have herpes zoster than patients without psoriasis. Among patients with psoriasis, those who developed herpes zoster had twice as many doctor's visits, 3 times as many emergency department visits, and twice as many inpatient hospital stays during the month after a herpes zoster diagnosis as patients without herpes zoster. This resulted in an additional cost of $1390 per patient with psoriasis and herpes zoster compared with those with psoriasis but without herpes zoster. Overall, patients with psoriasis are at increased risk of developing herpes zoster and the healthcare resource use and associated cost of treating herpes zoster in patients with psoriasis is substantial.

6.
Vaccine ; 41(37): 5360-5367, 2023 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-37541822

RESUMO

INTRODUCTION: Recombinant zoster vaccine (RZV) is recommended in the US for prevention of herpes zoster (HZ) in adults aged ≥50 years. Vaccination rates remain suboptimal for adults 50-59 years compared with adults ≥50 years overall. The objective of this study was to model changes in outcomes associated with improved RZV vaccination coverage in US adults 50-59 years. METHODS: A multicohort Markov model compared a scenario using real-world vaccination coverage for US adults 50-59 years in 2020 versus scenarios assuming higher coverage. Outcomes, based on a lifetime horizon, included HZ cases and complications avoided, quality-adjusted life-years (QALY), and costs. Model inputs included HZ epidemiology, RZV vaccine efficacy, coverage, adverse events, and costs, based on published literature and US sources. Some inputs were updated from previous models, including real-world estimates of RZV coverage, series completion, and reflecting longer-term data on waning of vaccine efficacy. The model utilized a cohort size of 42,756,488 individuals based on the 2020 US population census. RESULTS: The model projected that increasing RZV coverage in adults 50-59 years from 7.3 % to 14.6 % (to coverage for adults 60-64 years in 2020) would avoid an additional 504,468 HZ cases, 42,077 postherpetic neuralgia cases, and 56,247 cases of other HZ-associated complications. The increase in vaccine coverage would result in higher vaccination-related costs of $1,172,411,566, but the avoided HZ cases and complications would be expected to result in direct cost savings of $721,973,386 and indirect cost savings of $593,497,480 from avoided productivity loss. Overall, a gain of 5,230 discounted QALYs and cost savings of $143,059,299 from a societal perspective would be realized. CONCLUSION: Modestly higher RZV coverage in US adults 50-59 years could reduce the clinical burden associated with HZ and may result in societal cost savings. These findings demonstrate the potential value of increasing RZV vaccination in this population.


Assuntos
Vacina contra Herpes Zoster , Herpes Zoster , Neuralgia Pós-Herpética , Adulto , Humanos , Vacina contra Herpes Zoster/efeitos adversos , Análise Custo-Benefício , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Neuralgia Pós-Herpética/epidemiologia , Neuralgia Pós-Herpética/prevenção & controle , Vacinação , Vacinas Sintéticas , Herpesvirus Humano 3
7.
Crohns Colitis 360 ; 5(3): otad033, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-37497018

RESUMO

Background: Patients with ulcerative colitis (UC) or Crohn's disease (CD) are at increased risk of herpes zoster (HZ); however, relevant cost and healthcare resource utilization (HCRU) data are limited. Methods: We estimated HCRU (hospitalization, emergency department [ED], and outpatient visits) and costs in patients with UC or CD, with and without HZ, using administrative claims data (October 2015-February 2020). HCRU and costs (2020 US dollars) were compared at 1 month, 1 quarter, and 1 year after the index date, using propensity score adjustment and generalized linear models. Results: In total, 20 948 patients were included: UC+/HZ+ (n = 431), UC+/HZ- (n = 10 285), CD+/HZ+ (n = 435), and CD+/HZ- (n = 9797). Patients with HZ had higher all-cause HCRU rates and all-cause total healthcare costs relative to those without HZ. In the first month, adjusted incidence rate ratios (aIRRs) for hospitalizations and ED visits for patients with UC and HZ compared with UC alone were 2.87 (95% confidence interval [CI], 1.93-4.27) and 2.66 (95% CI,1.74-4.05), respectively; for those with CD and HZ, aIRRs were 3.34 (95% CI, 2.38-4.70) and 3.31 (95% CI, 2.32-4.71), respectively, compared with CD alone (all P < .001). Adjusted cost differences in UC and CD cohorts with HZ over the first month were $2189 and $3774, respectively, chiefly driven by higher inpatient costs. The incremental impact on HCRU and costs in cohorts with HZ predominantly occurred during the first quarter following diagnosis. Conclusions: HZ is associated with increased HCRU and costs in patients with UC and CD, especially shortly after diagnosis.

8.
Rheumatol Ther ; 10(4): 933-950, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37219822

RESUMO

OBJECTIVE: To estimate the incremental healthcare resource utilization (HRU) and cost burden posed by herpes zoster (HZ) in adult patients with rheumatoid arthritis (RA) in the United States. METHODS: A retrospective cohort study was conducted using an administrative claims database containing commercial and Medicare Advantage with Part D data, between October 2015 and February 2020. Patients with RA and HZ (RA+/HZ+) or RA without HZ (RA+/HZ-) were identified based on diagnosis codes and relevant medications. Outcomes measured included HRU and medical, pharmacy, and total costs at month 1, quarter 1, and year 1 after the index date (HZ diagnosis for RA+/HZ+ cohort, randomly assigned for RA+/HZ- cohort). Generalized linear models incorporating propensity scores and other covariates were used to estimate differences in outcomes between cohorts. RESULTS: A total of 1866 patients from the RA+/HZ+ cohort and 38,846 patients from the RA+/HZ- cohort were included. Hospitalizations and emergency department visits occurred more frequently in the RA+/HZ+ than the RA+/HZ- cohort, especially in the month after HZ diagnosis (adjusted incidence rate ratio [95% confidence interval (CI)] for hospitalizations: 3.4 [2.8; 4.2]; emergency department visits: 3.7 [3.0; 4.4]). Total costs were also higher in the month after HZ diagnosis (mean adjusted cost difference [95% CI]: $3404 [$2089; $4779]), with cost differences driven by increased medical costs ($2677 [$1692; $3670]). CONCLUSIONS: These findings highlight the high economic burden of HZ among individuals with RA in the United States. Strategies to reduce the risk of HZ in patients with RA (such as vaccination) may serve to reduce this burden. Video abstract.

9.
Gastroenterol Rep (Oxf) ; 11: goad016, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37064550

RESUMO

Background: Patients with inflammatory bowel disease (IBD) are at increased risk of herpes zoster (HZ). We evaluated the incidence of HZ in ulcerative colitis (UC) and Crohn's disease (CD) patients and compared this with HZ incidence in a non-IBD population. Methods: We conducted a retrospective cohort study (GSK study identifier: VEO-000043) of adults aged ≥18 years with UC and CD and without IBD who were identified from claims recorded in a US healthcare database between October 2015 and February 2020. Crude HZ incidence rates/1,000 person-years (PY) were calculated, and comparisons of HZ incidence rates between UC or CD and non-IBD cohorts were made using adjusted generalized linear models. Results: The study population comprised a total of 29,928 UC, 25,959 CD, and 11,839,329 non-IBD patients. Crude overall HZ incidence rates were 13.64/1,000 PY (UC), 15.94/1,000 PY (CD), and 7.95/1,000 PY (non-IBD). UC and CD patients had increased HZ incidence rates, with adjusted incidence rate ratios of 1.35 (95% confidence interval [CI], 1.26-1.44) and 1.66 (95% CI, 1.56-1.77), respectively, compared with non-IBD patients. Stratified analysis indicated increased relative rates of HZ in progressively younger age strata in the UC and CD patients compared with non-IBD patients. HZ incidence rates were higher in UC and CD patients who had previously received thiopurines or methotrexate, TNF-inhibitors, or corticosteroids than in UC and CD patients who did not take those medicines. Conclusion: UC and CD patients had increased HZ incidence rates compared with patients without IBD, demonstrating the importance of HZ prevention in IBD patients.

10.
Hum Vaccin Immunother ; 19(1): 2167907, 2023 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-36880669

RESUMO

Individuals who are immunocompromised (IC) due to therapy or underlying disease are at increased risk of herpes zoster (HZ). This study evaluates the public health impact of recombinant zoster vaccine (RZV) relative to no HZ vaccination for the prevention of HZ among adults aged ≥18 years diagnosed with selected cancers in the United States (US). A static Markov model was used to simulate three cohorts of individuals who are IC with cancer (time horizon of 30 years; one-year cycle length): hematopoietic stem cell transplant (HSCT) recipients, patients with breast cancer (BC; a solid tumor example), and patients with Hodgkin's lymphoma (HL; a hematological malignancy example). Cohort sizes reflect the estimated annual incidence of each condition in the US population (19,671 HSCT recipients, 279,100 patients with BC, and 8,480 patients with HL). Vaccination with RZV resulted in 2,297; 38,068; and 848 fewer HZ cases for HSCT recipients, patients with BC, and patients with HL, respectively (each versus no vaccine). Vaccination with RZV also resulted in 422; 3,184; and 93 fewer postherpetic neuralgia cases for HSCT, BC, and HL, respectively. Analyses estimated the quality-adjusted life years gained to be 109, 506, and 17 for HSCT, BC, and HL, respectively. To prevent one HZ case, the number needed to vaccinate was 9, 8, and 10, for HSCT, BC, and HL, respectively. These results suggest RZV vaccination may be an effective option to significantly reduce HZ disease burden among patients diagnosed with selected cancers in the US.


Shingles cases can be prevented by recombinant zoster vaccine (RZV). People who have a weakened immune system (immunocompromised) due to disease or therapy are more likely to develop shingles. For example, shingles occurs in nearly a quarter of patients receiving immunosuppressive treatment for blood cancers. To estimate the public health impact of vaccination against shingles in people who are immunocompromised due to cancer in the United States (US), we used a model to simulate groups with selected types of cancer. The results indicate vaccination with RZV can significantly reduce shingles cases and related complications among these groups in the US.


Assuntos
Neoplasias da Mama , Vacina contra Herpes Zoster , Herpes Zoster , Neuralgia Pós-Herpética , Humanos , Adulto , Estados Unidos , Adolescente , Feminino , Vacina contra Herpes Zoster/efeitos adversos , Saúde Pública , Análise Custo-Benefício , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Herpesvirus Humano 3 , Neuralgia Pós-Herpética/epidemiologia , Vacinas Sintéticas/efeitos adversos
11.
J Rheumatol ; 50(7): 873-880, 2023 07.
Artigo em Inglês | MEDLINE | ID: mdl-36725054

RESUMO

OBJECTIVE: To estimate the incidence of herpes zoster (HZ) in patients with rheumatoid arthritis (RA) compared with the general population in the USA. METHODS: This retrospective, longitudinal cohort study used data from an administrative claims database containing both commercial and Medicare Advantage Part D data, with a data period from October 2015 to February 2020. Patients were aged ≥ 18 years and divided into 2 cohorts: patients with RA and patients without RA. Diagnosis and procedure codes were used to identify HZ cases and calculate incidence rates (IRs) of HZ in the 2 cohorts. Data were stratified by age group (ie, 18-49, 18-29, 30-39, 40-49, 50-64, and ≥ 65 yrs) and RA therapy type. IR ratios (IRRs), adjusted by cohort baseline characteristics, were estimated using generalized linear models to compare the incidence of HZ between cohorts. RESULTS: The overall IR of HZ was higher in the RA cohort (21.5 per 1000 person-years [PY]; N = 67,650) than in the non-RA cohort (7.6 per 1000 PY; N = 11,401,743). The highest IRs in both cohorts were observed in the age group of ≥ 65 yrs (23.4 and 11.4 per 1000 PY in the RA cohort and non-RA cohort, respectively). The overall adjusted IRR of HZ was 1.93 (95% CI 1.87-1.99, P < 0.001) for the RA cohort compared with the non-RA cohort. In the RA cohort, the highest IRs by medication class were observed in patients using corticosteroids and those using Janus kinase inhibitors. CONCLUSION: These results highlight the increased incidence of HZ in patients with RA.


Assuntos
Antirreumáticos , Artrite Reumatoide , Herpes Zoster , Humanos , Idoso , Estados Unidos/epidemiologia , Estudos Retrospectivos , Incidência , Antirreumáticos/efeitos adversos , Estudos Longitudinais , Fatores de Risco , Medicare , Herpes Zoster/epidemiologia , Herpes Zoster/tratamento farmacológico , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Artrite Reumatoide/diagnóstico , Herpesvirus Humano 3 , Estudos de Coortes
12.
Hum Vaccin Immunother ; 18(1): 2027196, 2022 12 31.
Artigo em Inglês | MEDLINE | ID: mdl-35049412

RESUMO

Due to COVID-19, vaccinations dropped in 2020 and 2021. We estimated the impact of reduced recombinant zoster vaccine (RZV) use on herpes zoster (HZ) cases, complications, and quality-adjusted life-year (QALY) losses among older adults. Various scenarios were compared with Markov models using data from national sources, clinical trials, and literature. Missed series initiations were calculated based on RZV distributed doses. In 2020, 3.9 million RZV series initiations were missed, resulting in 31,945 HZ cases, 2,714 postherpetic neuralgia cases, and 610 lost QALYs. Scenarios further projected disease burden increases if individuals remain unvaccinated in 2021 or the same number of initiations are missed in 2021. Health professionals should emphasize the importance of vaccination against all preventable diseases during the COVID-19 era.


Assuntos
COVID-19 , Vacina contra Herpes Zoster , Herpes Zoster , Neuralgia Pós-Herpética , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Análise Custo-Benefício , Herpes Zoster/epidemiologia , Herpes Zoster/prevenção & controle , Herpesvirus Humano 3 , Humanos , Neuralgia Pós-Herpética/epidemiologia , Neuralgia Pós-Herpética/prevenção & controle , Pandemias , Estados Unidos/epidemiologia , Vacinação , Vacinas Sintéticas
13.
J Am Pharm Assoc (2003) ; 62(1): 95-103.e2, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34764037

RESUMO

BACKGROUND: Adult immunization rates in the United States remain low. More convenient access to immunization information systems (IIS) may improve vaccination rates. OBJECTIVE: The objective of this multilevel, clustered, randomized controlled study was to measure the impact of providing pharmacists with software and training to query IIS for patient vaccine history/recommendations on adult influenza, pneumococcal, herpes zoster, and Td/Tdap vaccination rates. METHODS: California Rite Aid pharmacy districts were randomized into intervention/control groups using stratified randomization based on baseline influenza vaccination rates. Store demographic characteristics were collected at baseline (January 1-December 31, 2018). During follow-up (April 1, 2019-March 31, 2020), intervention group stores received access to ImmsLink, software that allows health care providers to review immunization records from IIS and identify a patient's recommended vaccinations. The difference-in-difference between intervention and control groups compared the changes in vaccination rates from baseline to follow-up by calculating adjusted ratios of risk ratios (RRRs). Analysis was performed at the store level. RESULTS: Thirty-six districts comprising 501 Rite Aid stores (intervention: n = 244 stores; control: n = 257) were included. We found no significant differences in vaccination rates between groups: influenza, 19-64 years (adjusted RRR 0.99 [95% CI 0.83-1.17]); influenza, ≥65 years (1.02 [0.86-1.22]); herpes zoster (1.07 [0.90-1.28]); pneumococcal (0.95, 0.80-1.14); and Td/Tdap (0.88, 0.73-1.05). Reasons that recommended vaccines were not given in the intervention group included patient being deferred to future visit, patient declining, patient having already received the vaccination, patient declining because of cost, or vaccine being unavailable. Overall, pharmacist engagement with ImmsLink was low. CONCLUSION: Providing pharmacists with software and training to query IIS did not improve vaccination rates compared with control pharmacies in this study. Factors such as an inconvenient interface or inadequate training or motivation may have caused low engagement with the software and should be considered in future interventions.


Assuntos
Serviços Comunitários de Farmácia , Vacinas contra Influenza , Farmácias , Adulto , Humanos , Imunização , Programas de Imunização , Sistemas de Informação , Farmacêuticos , Estados Unidos , Vacinação
14.
J Adolesc Health ; 69(5): 762-768, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34518068

RESUMO

BACKGROUND: Routine adolescent vaccination recommendations in the United States include tetanus, diphtheria, and acellular pertussis, quadrivalent meningococcal conjugate vaccine, and human papillomavirus vaccines. Although coverage for these individual vaccines is known, limited data are available on composite completion for all three vaccines. METHODS: This cross-sectional analysis of pooled 2015-2018 National Immunization Survey-Teen data used logistic regression to estimate model-adjusted composite vaccination completion nationally and by state among United States adolescents aged 17 years. National Immunization Survey-Teen data were combined with state-level data to estimate a multilevel model identifying factors associated with composite vaccination completion. RESULTS: The pooled model-adjusted composite vaccination completion was 30.6% (95% confidence interval [CI], 30.13%-31.04%) nationally, varying from 11.3% in Idaho (6.91%-17.95%) to 56.4% (49.81%-62.82%) in Rhode Island. Individual-level factors with the greatest impact on composite completion were having a provider's recommendation for human papillomavirus vaccination (odds ratio, 3.24; 95% CI, 2.76-3.80) and a check-up visit at age 16-17 years (odds ratio, 2.35; 95% CI, 1.80-3.07), with other individual-level factors associated with completion including being Medicaid insured, female, Hispanic, or non-Hispanic black. State-level quadrivalent meningococcal conjugate vaccination mandates were also associated with an increased likelihood of composite vaccination completion (odds ratio, 1.64; 95% CI, 1.16-2.33). CONCLUSIONS: Fewer than one-third of 17-year-old individuals have completed all three recommended vaccines, with rates varying by state. Although this study identified implementable strategies to improve composite completion, additional research is needed to further understand factors associated with adolescent vaccination completion.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Vacinas Meningocócicas , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Adolescente , Estudos Transversais , Feminino , Humanos , Esquemas de Imunização , Estados Unidos , Vacinação , Vacinas Conjugadas
15.
Vaccine ; 39(36): 5187-5197, 2021 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-34334253

RESUMO

OBJECTIVE: This exploratory study estimates the economic value of the current vaccination program and increased coverage against four preventable diseases in older adults in the United States (US). METHODS: A population-based, age-structured economic model was used to conduct a cost-benefit analysis of vaccination against influenza, pertussis, herpes zoster, and pneumococcal disease among US adults aged 50 years and older, accounting for aging of the population. The model used separate decision trees for each disease to project the discounted number of vaccinated individuals, number of disease cases, and direct medical and indirect costs (2018 US$) over a 30-year period. Benefit-cost ratios (BCRs) and net present values were calculated for two primary analyses comparing current vaccination coverage versus no vaccination and comparing increased coverage versus current coverage. Key parameter values were varied in deterministic sensitivity analyses. RESULTS: Current adult vaccination coverage (vs. no vaccination) is estimated to result in nearly 65 million averted disease cases, $185 billion averted costs of cases, and $136 billion in incremental vaccination costs over a 30-year period from a societal perspective (BCR = 1.4). Increased vaccination coverage (vs. current coverage) is associated with over 33 million additional averted disease cases, $96 billion additional averted costs of cases, and nearly $83 billion in incremental vaccination costs, resulting in a societal BCR of 1.2 over 30 years. Deterministic sensitivity analyses demonstrated that results were most sensitive to disease incidence, vaccine efficacy, and productivity costs for time required for vaccination. CONCLUSIONS: Study results highlight the economic value of vaccination programs for older adults in the US and indicate that efforts to further increase vaccination coverage may be warranted and economically justifiable.


Assuntos
Vacinas contra Influenza , Vacinação , Idoso , Envelhecimento , Análise Custo-Benefício , Humanos , Programas de Imunização , Pessoa de Meia-Idade , Estados Unidos/epidemiologia
16.
Vaccine ; 39(19): 2660-2667, 2021 05 06.
Artigo em Inglês | MEDLINE | ID: mdl-33849722

RESUMO

BACKGROUND: Serogroup B meningococcal (MenB) vaccination recommendations for adolescents in the United States (US) include routine vaccination for all individuals at increased risk and vaccination for individuals not at increased risk aged 16-23 years (preferred age 16-18 years) based on shared clinical decision-making. The two licensed MenB vaccines require administration of ≥2 doses. METHODS: This cross-sectional study analyzed 2017-2018 National Immunization Survey-Teen (NIS-Teen) data to evaluate ≥1 dose and ≥2 dose MenB vaccination coverage among adolescents aged 17 years. Multivariable logistic regression was used to further evaluate determinants of MenB vaccination. RESULTS: Nationally, MenB vaccination coverage among 17-year-olds increased from 14.5% in 2017 to 17.2% in 2018 for ≥1 dose and from 6.3% to 8.4% for ≥2 doses. MenB vaccination coverage (2017-2018) was the lowest in the South (≥1 dose: 14.6%; ≥2 doses: 6.3%) and highest in the Northeast region (18.3% and 9.3%), with variation observed by census division. Adolescents were more likely to have received ≥1 dose of MenB vaccine if they had any Medicaid insurance (odds ratio [OR], 1.77; 95% confidence interval [CI], 1.32-2.39) or had received human papillomavirus (OR, 1.94; 95% CI, 1.41-2.67) or meningococcal A, C, W, and Y (OR, 4.03; 95% CI, 2.92-5.56) vaccinations. CONCLUSIONS: MenB first-dose coverage in the US is low, and even lower for a second dose, with regional variation. Being up to date with other routinely administered vaccines increased the likelihood of receiving MenB vaccination.


Assuntos
Infecções Meningocócicas , Vacinas Meningocócicas , Neisseria meningitidis Sorogrupo B , Adolescente , Adulto , Estudos Transversais , Humanos , Infecções Meningocócicas/epidemiologia , Infecções Meningocócicas/prevenção & controle , Estados Unidos , Vacinação , Cobertura Vacinal , Adulto Jovem
17.
Pharmacoecon Open ; 5(3): 411-423, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33860921

RESUMO

BACKGROUND: Adult vaccination rates in the USA are generally low and fall short of public health goals. OBJECTIVES: Our aim was to evaluate the effect of state-level characteristics on adult vaccination coverage in the USA. METHODS: This study was a cross-sectional, retrospective analysis of 2015-2017 Behavioral Risk Factor Surveillance System data, conducted from March to October 2019 and including seasonal influenza; pneumococcal; tetanus, diphtheria, and acellular pertussis (Tdap); and herpes zoster (HZ) vaccines. Multilevel logistic regression models examined interstate vaccination coverage variability and assessed the impact of state-level characteristics, with model-adjusted coverage estimated. RESULTS: Model-adjusted vaccination coverage varied by state, with 35.1-48.1% coverage for influenza (2017), 68.2-80.8% for pneumococcal (2017), 21.9-46.5% for Tdap (2016), and 30.5-50.9% for HZ (2017). Characteristics associated with vaccination included state-level insurance coverage, pharmacists' vaccination authority, vaccination exemptions, and adult immunization information systems participation, as well as individual-level measures of income and education. After adjusting for these factors, substantial interstate heterogeneity remained. CONCLUSIONS: Model-adjusted coverage was generally low and varied by state. A small number of state-level characteristics partially explained interstate coverage variability. This and future research assessing additional state characteristics may help determine policies most likely to increase adult vaccination.


Adult vaccination rates in the USA are generally low and fall short of public health goals. Previous studies have indicated that adult vaccination rates vary between states and that individual characteristics affect vaccination coverage. We used modeling to evaluate the effects of both individual- and state-level factors on adult vaccination coverage. Health insurance coverage, the authority of pharmacists to vaccinate, existence of vaccination exemptions, and immunization information systems adult participation rates had a positive impact on vaccination coverage, although the impact varied by vaccine. These results provide policy decision makers at both state and federal levels with information to consider when expanding vaccination programs or preventive care efforts. However, additional data are needed to further explain the variations between states.

18.
Hum Vaccin Immunother ; 17(2): 332-343, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-32758069

RESUMO

Despite vaccination recommendations, the burden of vaccine-preventable diseases remains high in older adults in the United States (US), contributing to substantial morbidity, mortality, and health care resource use and costs. To adequately plan for health care resource needs and to help inform vaccination policies, burden of disease projections that account for population aging over the coming decades are needed. As a first step, this exploratory study projects the burden of influenza, pertussis, herpes zoster, and pneumococcal disease in adults aged 50 y and older in the US, using a population-based modeling framework with separate decision trees for each vaccine-preventable disease. The model uses projected population estimates from the US Census Bureau to account for changes in the US population over time and then calculates expected numbers of cases and associated costs for each disease, keeping current estimates of age-specific disease incidence, vaccine coverage, and efficacy constant over time. This approach was used to focus the exploratory analysis on the burden of disease that may be expected due to population changes alone, assuming that all else remains unchanged. Due to population growth and the shifting age distribution over the next 30 y, the annual societal economic burden for the four vaccine-preventable diseases is projected to increase from approximately $35 billion to $49 billion, resulting in cumulative costs of approximately $1.3 trillion, as well as more than 1 million disease-related deaths. Given such notable burden, further efforts to increase vaccination coverage and effectiveness in older adults are needed.


Assuntos
Herpes Zoster , Vacinas contra Influenza , Doenças Preveníveis por Vacina , Idoso , Envelhecimento , Humanos , Estados Unidos/epidemiologia , Vacinação
19.
Vaccine ; 38(14): 2984-2994, 2020 03 23.
Artigo em Inglês | MEDLINE | ID: mdl-32115298

RESUMO

BACKGROUND: Early provisions of the Affordable Care Act (ACA) reduced financial barriers to preventive care, including routinely recommended vaccines; however, vaccination coverage remains suboptimal. This study examined characteristics of routine adult vaccinations and potential missed opportunities for vaccinations through the lens of healthcare resource utilization among adults in the ACA era. METHODS: This was a retrospective analysis of healthcare claims from the Truven Health MarketScan Commercial Claims and Encounters (CCAE), Medicare Supplemental (MS), and Multi-State Medicaid databases among adults aged 19 years or older. Influenza, Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis), herpes zoster (HZ), and pneumococcal vaccinations were identified between 2011 and 2016. Potential missed opportunities were defined as well-visits at which individuals were age-eligible for vaccination but did not receive it, assessed during recommended windows for each vaccine. Missed encounters were defined as having no well-visits. Multivariable logistic regression was used to identify factors associated with vaccination and potential missed opportunities. RESULTS: Family/internal medicine and unknown/other providers administered most influenza, Tdap, and pneumococcal vaccinations, for the CCAE/MS and Medicaid cohorts, respectively. HZ vaccinations were primarily administered through pharmacies. The proportion of vaccination events increased in the pharmacy setting between 2011 and 2016. Having preventive care visits, non-well-visits, and receiving most care from a family/internal medicine practitioner were associated with increased odds of vaccination. Missed encounters were common in Medicaid enrollees. Potential missed opportunities were more prevalent in the CCAE/MS cohort than among Medicaid enrollees. Having non-well-visits was associated with a reduced likelihood of having a missed opportunity. CONCLUSION: Since the ACA implementation, preventive care among adults was sporadic. Many adults had limited opportunities for vaccination. The large prevalence of missed opportunities suggests vaccination uptake could be improved. Better support for vaccination or referrals for providers who may not traditionally vaccinate could improve vaccine uptake.


Assuntos
Patient Protection and Affordable Care Act , Vacinação/estatística & dados numéricos , Vacinas/administração & dosagem , Adulto , Idoso , Humanos , Medicare , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Estudos Retrospectivos , Estados Unidos , Vacinação/economia , Adulto Jovem
20.
J Oncol Pract ; 12(2): 159-67, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26395563

RESUMO

PURPOSE: Overexpression of the human epidermal growth factor receptor 2 (HER2) protein negatively affects survival in breast cancer. This study aimed to assess real-world treatment patterns and costs associated with resected nonmetastatic HER2-positive breast cancer in the United States. PATIENTS AND METHODS: Commercially insured patients with HER2-positive breast cancer were identified from oncology registry data linked to a large US commercial administrative claims database. Treatment patterns and health care use and costs in the initial phase of care were examined. RESULTS: Among the 915 patients who met the study criteria, 662 (72%) were hormone receptor (HR) positive, and 253 (28%) were HR negative. Overall, 72% (n = 662) of patients received HER2-targeted therapy (HR positive, 69% v HR negative, 80%; P < .01), specifically trastuzumab. The most common treatment regimens, regardless of HR status, were carboplatin, docetaxel, and trastuzumab (47% of patients) during neoadjuvant therapy and carboplatin, docetaxel, and trastuzumab ± hormone therapy (30% of patients) during adjuvant therapy. Overall unadjusted cost of treatment per patient per month (HR positive, $11,906 v HR negative, $14,367; P < .001) was mainly cancer related (HR positive, $10,513 v HR negative, $13,073; P < .001). Adjusted 12-month cost was $176,779 (HR positive, $167,088 v HR negative, $180,226; P > .05). CONCLUSION: Although trastuzumab-based therapy is considered standard of care among patients with HER2-positive early-stage breast cancer, approximately 28% of these patients did not receive HER2-targeted therapy. Additional studies are warranted to examine whether patients who have not received targeted therapy are eligible for and would benefit from an HER2-targeted approach.


Assuntos
Neoplasias da Mama/epidemiologia , Custos de Cuidados de Saúde , Padrões de Prática Médica , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/etiologia , Neoplasias da Mama/terapia , Terapia Combinada , Bases de Dados Factuais , Feminino , Expressão Gênica , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Receptor ErbB-2/genética , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
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