Dongmu Zhang

Herpes zoster incidence and cost in patients receiving autologous hematopoietic stem-cell transplant

Abstract Objective: Among patients receiving autologous hematopoietic stem cell transplant (Auto-HSCT), this study estimated the incidence of herpes zoster (HZ), compared healthcare costs among patients with and without HZ, and evaluated antiviral prophylaxis (AP) use. Research design and methods: A retrospective study was conducted using data from a large health plan to identify patients ≥18 years with ≥1 claim for an Auto-HSCT procedure during 2006–2011 (n = 2,530). Patients were followed from date of Auto-HSCT until risk-end date, defined as development of HZ, end of enrollment, death, or December 31, 2011. HZ incidence was calculated as cases observed after Auto-HSCT, divided by accrued time-at-risk in person-years (PY). AP use and duration were defined by prescription fills. One-year medical and pharmacy costs were calculated as combined health plan and patient paid amounts. Main outcome measures: HZ incidence and healthcare costs were calculated using administrative claims data. Results: Overall HZ incidence was 62.2/1,000 PY (95% CI = 54.3–70.9). Most (72.3%) patients were prescribed AP. During the first 90-days post-Auto-HSCT, patients without AP had increased incidence (151.6/1,000 PY, 95% CI = 88.3–242.6) compared to those prescribed AP pre- (30.9/1,000 PY, 95% CI = 11.3–67.2) or post-Auto-HSCT (33.0/1,000 PY, 95% CI = 13.3–67.9). Total adjusted mean 1-year all-cause healthcare costs were

Initiation & completion rates of hepatitis A vaccination among US pediatric populations born between 2005 and 2009

74,875 for patients who developed HZ and

Adherence with and completion of recommended hepatitis vaccination schedules among adults in the United States

70,279 for patients who did not (difference = 

Hepatitis A and Hepatitis B Recombinant Vaccine Adherence In The United States

4,596 (cost ratio = 1.07, 95% CI = 0.86–1.32, p = .566)). Conclusions: HZ incidence was high, despite AP use. Mean annual healthcare costs were higher for patients with HZ, but the difference was not statistically significant. An effective vaccine against HZ could be useful in decreasing both incidence of and cost for HZ in this population.

Adherence to Multi-Dose Hepatitis A and Hepatitis B Vaccine Schedules in the United States

OBJECTIVES To estimate hepatitis A vaccine series initiation and completion rates, assess time to vaccination, identify missed opportunities for the hepatitis A vaccine series, and examine factors associated with hepatitis A vaccine series initiation and completion. METHODS We conducted a retrospective, observational study using three healthcare claims databases separately. The study population was comprised of children born between years 2005 and 2009 that were continuously enrolled for at least three and a half years from the date of birth. Every child was followed from date of birth for three and a half years for hepatitis A vaccination. RESULTS There were 93,735 eligible children from Clinformatics Data Mart, 202,513 from MarketScan Commercial, and 207,545 from MarketScan Medicaid. The overall hepatitis A vaccine series initiation rate was 63.8-79.4% and completion rate was 45.1-66.8% across the three databases. About 62.8-90.1% of the children who never initiated hepatitis A vaccine had at least one well visit from 1 year to three and a half years old. Children were more likely to initiate and complete the hepatitis A vaccine series if they were from more recent birth cohorts, from states with a hepatitis A vaccination recommendation prior to the ACIP universal recommendation, from states with daycare/school entry requirements, were enrolled in an HMO health plan, had pediatricians as primary providers, had more doctors office/well visits and received MMR/Varicella vaccines. CONCLUSION In this study, approximately one in every three to five children remained unvaccinated against hepatitis A. Although the hepatitis A vaccine series initiation and completion improved from 2005 to 2009, vaccine coverage has stabilized in recent years. It is important for providers to identify every opportunity for hepatitis A vaccination and to assure that children get protection from this vaccine-preventable disease.

Characterisitcs and Drug Utilization among Treated Chronic Hepatitis C Virus (Chc) Patients with and without Chronic Kidney Disease (Ckd) in the Us

INTRODUCTION Adult vaccination coverage rates in the US are well below national targets, leaving many adults at increased risk. Additionally, typical vaccination coverage calculations do not adequately approximate population immunity as they do not consider whether multidose vaccines were administered within the recommended schedules. As timely administration of each dose optimizes overall vaccine effectiveness, we sought to document adherence to and completion of the hepatitis A (HepA), hepatitis B (HepB), and combined hepatitis A and hepatitis B (HepA-HepB) multidose vaccine schedule in an insured adult population in the US. METHODS We conducted a retrospective database study of administrative claims from 2008 to 2015 (analyzed in 2017). Completion of 2 (HepA) and 3 doses (HepB and HepA-HepB), and adherence to the 2- and 3-dose recommended schedules were measured among individuals aged 19 years and older at first dose. The proportion of patients who completed 2 and 3 doses and were adherent to the recommended schedule were estimated using Kaplan-Meier methods. RESULTS For HepA, 27.14% of initiating adults were adherent to the recommended schedule, and 32.05% had received a second dose by 42 months. Approximately one-third of adults who initiated the HepB or HepA-HepB series completed all 3 doses within 2 years of the minimum spacing (31.17% and 32.27%, respectively). Generally, completion and adherence were highest in individuals aged 60-64 years at the time of initiation. CONCLUSIONS Hepatitis vaccine adherence and completion in adults is suboptimal. As a result, the majority of adults initiating each series may not be receiving the full protective benefit of these multidose vaccines.