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

ArticleinPEDIATRICS 121(2):253-60 · February 2008with12 Reads
Impact Factor: 5.47 · DOI: 10.1542/peds.2007-0619 · Source: PubMed
Abstract

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.

    • "...s associated with a 41% reduction in antibiotic prescriptions for OM in children aged <2 year-olds [17]. In France and the Netherlands, too, antibiotics prescriptions for OM fell significantly among 6-mo..."
      This is consistent with a recent US study using a health insurance claims database, there was a significant reduction in primary care visits for OM and recurrent OM following PCV13 introduction, mainly in <2 year-olds [34]. In the US, PCV7 introduction was associated with a 41% reduction in antibiotic prescriptions for OM in children aged <2 year-olds [17]. In France and the Netherlands, too, antibiotics prescriptions for OM fell significantly among 6-month to 2 year-olds and 1–9 year-olds, respectively, after PCV7 intro- duction [35,36].
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Aug 2015 · Vaccine
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    • "...(IPD)123, pneumonia4567 otitis media [8], and pneumococcal carriage [9] in children. Radiographically confirmed alveolar pneumonia, as defined by the World Health Organization (WHO), is considered most ..."
      (IPD)123, pneumonia4567 otitis media [8], and pneumococcal carriage [9] in children. Radiographically confirmed alveolar pneumonia, as defined by the World Health Organization (WHO), is considered most often a bacterial disease and served therefore as an endpoint for vaccine efficacy studies in several pivotal pneumococcal conjugate vaccine (PCV) pre-licensure studies [10].
    [Show abstract] [Hide abstract] ABSTRACT: Alveolar community-acquired pneumonia (A-CAP) is mostly considered a bacterial disease, mainly pneumococcal. This study was conducted to document the impact of sequential 7-valent and the 13-valent pneumococcal conjugate vaccines (PCV7; PCV13) on emergency room and hospitalization for A-CAP among children <5 years of age. This is an ongoing prospective population-based study in southern Israel. The current analysis spans over the period July 2002 through June 2013. A-CAP was defined using the World Health Organization (WHO)'s criteria for radiologically-confirmed pneumonia. PCV7 was introduced in Israel in July 2009 and gradually replaced by PCV13 in November 2010. Pneumococcal conjugate vaccine (PCV) impact was calculated by comparing incidences during 3 pre-defined periods: pre-PCV (2002-2008), PCV7 (2010-2011) and PCV13 (2012-2013). Overall, 10,142 A-CAP episodes occurred. The annual incidences (per 1,000 inhabitants) in children <5 years old declined from a mean (±standard deviation) of 13.8±0.9 in the pre-PCV period to 11.2±2.7 in the PCV7 period and 7.4 in the PCV13 period, representing a reduction of 13% and 47%, respectively. The overall decrease was significantly faster among outpatients than among hospitalized children (42% and -8%, respectively in the PCV7 period; 68% vs. 32% in hospitalized children in the PCV13 period). While in children 12-23 months a significant decline was observed during the PCV7 and PCV13 periods, significant declines in A-CAP rates were observed only during the PCV13 period in the <12 months and 24-59 months age groups (44% and 46%, respectively). A moderate decline in hospital A-CAP visits in children <5 years old was observed after PCV7 introduction. In contrast, after PCV13 introduction a substantial reduction in all visits was evident. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Jun 2015 · Vaccine
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    • "...tional database, several of them also found protective effect PCV on otitis media for children [9, 37, 47, 48]. Poehling et al. demonstrated less frequent otitis media visits and tube insertions in a mo..."
      The reasons may be that surgical interventions are not favorable choices of Taiwanese parents, leading to more conservative management, or otolaryngologists in Taiwan adhered more to the suggestions of clinical practice guideline in comparison to surgeons in the United States on treatment of pediatric otitis media with effusion676869. For previous studies analyzing observational database, several of them also found protective effect PCV on otitis media for children [9, 37, 47, 48]. Poehling et al. demonstrated less frequent otitis media visits and tube insertions in a more recent cohort of children covered by Tenn Care and New York private insurance [48].
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Apr 2015
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