Trends in Acute Otitis Media-Related Health Care Utilization by Privately Insured Young Children in the United States, 1997-2004

National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mail Stop E-52, Atlanta, GA 30333, USA.
PEDIATRICS (Impact Factor: 5.47). 02/2008; 121(2):253-60. DOI: 10.1542/peds.2007-0619
Source: PubMed


The goal was to estimate the population effect of 7-valent pneumococcal conjugate vaccine on rates of acute otitis media-related ambulatory visits and antibiotic prescriptions for <2-year-old children enrolled in private insurance plans.
We performed a retrospective analysis of a defined population by using the 1997-2004 MarketScan databases, which included an average of >500,000 person-years of observations for children <2 years of age. Trends in rates of International Classification of Diseases, Ninth Revision-coded ambulatory visits and antibiotic prescriptions attributable to acute otitis media were evaluated, and the national direct medical expenditures for these outcomes were estimated.
In a comparison of 2004 with 1997-1999 (baseline period), rates of ambulatory visits and antibiotic prescriptions attributable to acute otitis media decreased from 2173 to 1244 visits per 1000 person-years (42.7% reduction) and from 1244 to 722 prescriptions per 1000 person-years (41.9% reduction), respectively. Total, estimated, national direct medical expenditures for acute otitis media-related ambulatory visits and antibiotic prescriptions for children <2 years of age decreased from an average of $1.41 billion during 1997 to 1999 to $0.95 billion in 2004 (32.3% reduction).
Acute otitis media-related health care utilization and associated antibiotic prescriptions for privately insured young children decreased more than expected (on the basis of efficacy estimates in prelicensure clinical trials) after the introduction of routine 7-valent pneumococcal conjugate vaccine immunization. Although other factors, such as clinical practice guidelines to reduce antibiotic use, might have contributed to the observed trend, 7-valent pneumococcal conjugate vaccine may play an important role in reducing the burden of acute otitis media, resulting in substantial savings in medical care costs.

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    • "The reduction in PCV7-type pneumococcal infections, however, was associated with an increase in non-vaccine serotypes in carriage and, consequently, in invasive disease, led to replacement of PCV7 in national immunization schedules with a 13-valent vaccine (PCV13) that provided protection against six additional serotypes (1, 3, 5, 6A, 7F and 19A) [7] [8].In the UK, PCV13 replaced PCV7 in April 2010 without a catch-up for older children. In other developed countries in Europe and North America, the success of PCV7 in reducing community acquired-pneumonia and OM has been demonstrated in a number of clinical trials and observational studies [9] [10] [11] [12] [13] [14] [15] [16] [17]. However, in the UK the impact of PCV7 to OM reduction and associated antibiotic prescription rates, where 2-dose infant schedule with a booster after 12 months of age was introduced, has not been assessed. "
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    ABSTRACT: Studies have demonstrated a reduction for otitis media (OM) following the introduction of seven-valent pneumococcal conjugate vaccine (PCV7), but this has not been evaluated in the United Kingdom (UK). Moreover, there are limited data on any additional impact of PCV13 introduction in 2010. We conducted an observational cohort study to investigate the trends in OM incidence and associated antibiotic prescriptions in children aged <10 year-olds during 2002-2012 using a national primary care database. Three time-periods were defined to estimate monthly incidence: pre-PCV7 (January 2002-August 2006), post-PCV7 (September 2007-March 2010), and post-PCV13 (April 2011-December 2012). Overall annual OM incidence declined by 51.3% from 135.8 episodes/1000 person-years in 2002 to 66.1 episodes/1000 person-years in 2012; antibiotic prescription rates for OM declined by 72.9% from 57.9 prescriptions/1000 person-years to 15.7 prescriptions/1000 person-years, respectively. PCV7 introduction was associated with significant decline in OM rates across all age-groups (21.8%; 95% CI, 20.2-23.4), including <2 year-olds (19.8%; 95% CI, 16.0-23.5%); 2-4 year-olds (23.0%; 95% CI, 20.4-25.4%) and 5-9 year-olds (20.2%; 95% CI, 17.6-22.7%). There was an additional significant reduction in OM (18.5%; 95% CI, 16.7-20.2%) and associated antibiotic prescribing (12.2%; 95% CI, 8.6-15.6%) after the introduction of PCV13 across all age-groups. The introduction of PCV7 was associated with a 22% significant reductions in OM in children aged <10 year-olds with an additional 19% reductions after PCV13 introduction. These declines are equivalent to 592,000 and 15,700 fewer consultations and OM-related hospitalizations, respectively, in England and Wales every year. Although the continuing decline in OM rates in our study suggests that further reduction may continue to occur, it is important to monitor long-term trends in all pneumococcal diseases, including OM and pneumonia, because of increasing replacement of non-vaccine pneumococcal serotypes in carriage and disease. Copyright © 2015. Published by Elsevier Ltd.
    Vaccine 08/2015; 33(39). DOI:10.1016/j.vaccine.2015.08.022 · 3.62 Impact Factor
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    • "In addition to protective effects against pneumonia and IPD, PCV7 also reduced pediatric otitis media and the rate of tympanostomy tube insertions. In comparison with pneumonia and IPD, otitis media affects more children and it is associated with a greater social and economic burden than any other pneumococcal diseases [36] [37] [38]. "
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    ABSTRACT: Objective. To investigate the impact of seven-valent pneumococcal conjugate vaccine on tube insertions in a partial immunized pediatric population. Study Design. Retrospective ecological study. Methods. This study used Taiwan National Health Insurance Research Database for the period 2000-2009. Every child under 17 years old who received tubes during this 10-year period was identified and analyzed. The tube insertion rates in different age groups and the risk to receive tubes in different birth cohorts before and after the release of the vaccine in 2005 were compared. Results. The tube insertion rates for children under 17 years of age ranged from 21.6 to 31.9 for 100,000 persons/year. The tube insertion rate of children under 2 years old decreased significantly after 2005 in period effect analysis (β = −0.074, P < 0.05, and the negative β value means a downward trend) and increased in children 2 to 9 years old throughout the study period (positive β values which mean upward trends, P < 0.05). The rate of tube insertion was lower in 2004-2005 and 2006-2007 birth cohorts than that of 2002-2003 birth cohort (RR = 0.90 and 0.21, 95% CI 0.83-0.97 and 0.19-0.23, resp.). Conclusion. The seven-valent pneumococcal conjugate vaccine may reduce the risk of tube insertion for children of later birth cohorts. The vaccine may have the protective effect on tube insertions in a partial immunized pediatric population.
    04/2015; 2015:1-8. DOI:10.1155/2015/248678
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    • "Following introduction of the 7-valent pneumococcal conjugate vaccine (PCV7), childhood incidence of AOM declined in the USA and Canada. In children aged under 2 years, a 43% reduction in AOM, 42% reduction in antibiotic prescription, and 32% reduction in AOM-related costs has been observed.65 Canadian studies have shown an overall decline of 25.2% in AOM from 2000 to 2007, with 13.2% attributed to the vaccine, and with the largest impact in children under 2 years old.64 "
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    ABSTRACT: Acute otitis media and otitis media with effusion are common childhood disorders, a source of significant morbidity, and a leading cause of antibiotic prescription in primary health care. Although effective treatments are available, some shortcomings remain, and thus better treatments would be welcome. Recent discoveries within the field of otitis media research relating to its etiology and pathogenesis have led to further investigation aimed at developing novel treatments. This article provides a review of the latest evidence relating to the understanding of acute otitis media and otitis media with effusion, current treatment strategies, their limitations, new areas of research, and novel strategies for treatment.
    Infection and Drug Resistance 01/2014; 7:15-24. DOI:10.2147/IDR.S39637
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