On-label and off-label use of high-dose influenza vaccine in the United States, 2010-2012.
High-dose inactivated, influenza vaccine was licensed by the FDA in December 2009 for adults aged 65 y and older. The ACIP did not issue or state a preference for a specific vaccine in the elderly population. The extent of its on-label and off-label use is unknown. Using the MarketScan Commercial Claims and Encounters and the Medicare Supplemental database, we identified individuals who received the high-dose influenza vaccine or the standard, seasonal trivalent influenza vaccine between January 1, 2010 and December 31, 2012. For people aged ≥65 y, we used multivariable regression to assess the association between patient and provider level variables and high-dose influenza vaccine versus standard influenza vaccine. We characterized all off-label high-dose vaccine administered to people younger than 65 y of age, and investigated whether sicker patients were targeted for off-label use by examining the association between various comorbid conditions and receipt of the high-dose vaccine among adults aged 18-64. Among patients aged ≥65 y who received an influenza vaccine, 18.4% received the high-dose vaccine. Uptake was minimal in 2010, but 25% and 32% of influenza shots were the high-dose formulation in 2011 and 2012, respectively. Almost 27,000 seniors received a second high-dose vaccine with a median of 368 d (IQR: 350-387 days) between doses. Older age, family practice physicians, and having PPO insurance were positively associated with receiving high-dose vaccine. There were 36,624 off-label high-dose vaccines administered. Half of the patients receiving off-label doses were aged 50-64. Adults aged 18-64 y receiving high-dose vaccine were more likely to have chronic comorbidities than people receiving standard influenza vaccine; however, there was not one specific illness that seemed to be targeted by physicians. In the first 3 y since licensure, use of the high-dose vaccine among seniors has been limited. The safety of this vaccine should be monitored closely among 2 groups of people - seniors receiving repeat doses and people <65.
a Department of Epidemiology; Gillings School of Global Public Health ; University of North Carolina ; Chapel Hill , NC USA.
Leah J
LJ
McGrath
M Alan
MA
Brookhart
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004363:Drug Utilization; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage*; D007251:Influenza, Human / Q000517:prevention & control*; D008875:Middle Aged; D056687:Off-Label Use; D014481:United States; D015164:Vaccines, Inactivated / Q000008:administration & dosage; D055815:Young Adult
D007252:Influenza Vaccines; D015164:Vaccines, Inactivated
ACIP, Advisory Committee on Immunization Practices; CPT, Current Procedural Terminology; HMO, Health Maintenance Organization; ICD-9-CM, International Classification of Diseases; Interquartile range; Ninth Revision, Clinical Modification, IQR; PPO, Preferred provider organization; adult vaccination; high-dose influenza vaccine; influenza prevention; influenza vaccine