title: Clinical and cost burden of rotavirus infection before and after introduction of rotavirus vaccines among commercially and Medicaid insured children in the United States.
abstract: This study aims to quantify clinical and economic burden of rotavirus (RV) infection pre- and post-vaccine introduction in commercially insured and Medicaid populations. Beneficiaries with continuous enrollment for ≥6 months while <5 years of age were identified separately in commercial (2000-2010) and Medicaid (2002-2009) claims databases. Commercial and Medicaid databases included 3,998,708 and 1,034,440 eligible children, respectively, observed from enrollment start date(s) to end of eligibility or 5-years-old. Rates of RV-coded and diarrhea-coded encounters and first RV episodes, and incremental cost of first RV episodes were calculated. In the post-vaccine period, rates per 10,000 person-years for RV-coded hospitalizations, outpatient visits and ER visits were 5.58 (95% CI, 5.37-5.80), 6.96 (95% CI, 6.75-7.20), and 4.85 (95% CI, 4.66-5.06), respectively (pre-vaccine, 16.67 [95% CI, 16.19-17.15], 13.20 [95% CI, 12.78-13.63], 11.26 [95% CI, 10.87-11.66], respectively), for commercially insured. In Medicaid the corresponding rates were 10.53 (95% CI, 9.60-11.56), 11.72 (95% CI, 10.73-12.80), and 9.11 (95% CI, 8.24-10.07) (pre-vaccine, 19.78 [95% CI, 19.14-20.45], 19.39 [95% CI, 18.75-20.05], 27.61 [95% CI, 26.84-28.40]). Incidence rate per 10,000 person-years for first RV episode pre- vs. post-vaccine were 27.03 (95% CI, 26.42-27.65) vs. 10.14 (95% CI, 9.86-10.44) in the commercially insured population and 37.71 (95% CI, 36.81-38.63) vs. 18.64 (95% CI, 17.37-19.99) in Medicaid. Incremental per-patient per-month cost of first RV episode was $3363 (95% CI, $3308-$3418) among commercially insured and $1831 (95% CI, $1768-$1887) in Medicaid. Since vaccine introduction clinical burden of RV disease decreased among children; costs associated with RV episodes remained significant across insured populations.
authors.affiliation: a GlaxoSmithKline Vaccines; King of Prussia, PA USA.
authors.forename: Girishanthy
authors.initials: G
authors.lastname: Krishnarajah
authors.forename: Kitaw
authors.initials: K
authors.lastname: Demissie
authors.forename: Patrick
authors.initials: P
authors.lastname: Lefebvre
authors.forename: Sunanda
authors.initials: S
authors.lastname: Gaur
authors.forename: Mei
authors.initials: M
authors.lastname: Sheng Duh
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D059033:For-Profit Insurance Plans; D017048:Health Care Costs; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008297:Male; D008484:Medicaid; D015995:Prevalence; D012189:Retrospective Studies; D012400:Rotavirus Infections / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control*; D022243:Rotavirus Vaccines / Q000008:administration & dosage*; D014481:United States / Q000453:epidemiology
chemical_list: D022243:Rotavirus Vaccines
keywords: diarrhea; economic; hospitalization; resource utilization; rotavirus; vaccine