scholarly journals 07. Recombinant Zoster Vaccine (RZV) Second-Dose Completion in Adults Age 50‒64 Years in the United States

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S127-S127
Author(s):  
Jessica Leung ◽  
Elizabeth B Gray ◽  
Tara Anderson ◽  
Sarah M Sharkey ◽  
Kathleen L Dooling
Keyword(s):  
The United States ◽  
Administrative Claims ◽  
Completion Rates ◽  
Medicare Beneficiaries ◽  
Medical Provider ◽  
Zoster Vaccine ◽  
National Drug ◽  
Series Completion ◽  
Recombinant Zoster Vaccine

Abstract Background In 2018, CDC recommended a highly efficacious adjuvanted recombinant zoster vaccine (RZV, Shingrix) as a 2-dose series for prevention of herpes zoster (HZ) for immunocompetent persons age ≥50 years, with the 2nd dose recommended 2–6 months after the 1st dose. Among Medicare beneficiaries, 2-dose series completion 6 months and 12 months post initiation was 78% and 86%, respectively. Here we estimate the proportion of adults age 50–64 years who completed the 2-dose RZV series within 6 or 12 months after receiving their 1st dose, by using two administrative claims databases. Methods We used medical and pharmaceutical claims data from October 2017‒March 2020 IQVIA® PharMetrics Plus and October 2017‒October 2020 IBM® MarketScan® databases. RZV vaccination was defined using Current Procedural Terminology and National Drug Codes. We allowed for sufficient follow-up time by examining 1st doses given at least 6 or 12 months prior to the end of the study period in both databases. Place of administration was available in IQVIA data. Results Among persons age 50‒64 years, in IQVIA and MarketScan, 70% and 68% received their 2nd RZV dose within 6 months, respectively, and 79% and 81% received their 2nd dose within 12 months, respectively. The median age of 1st dose of RZV vaccination was 60 years and ~60% were female [Table 1]. When the 2nd dose was administered within 12 months, the median interval between 1st and 2nd doses was 104 and 98 days in the IQVIA and MarketScan databases, respectively. Characteristics by age, sex, or region were similar in persons who received 1 RZV dose vs. 2 RZV doses [Table 1]. Among those who received only 1 RZV dose with at least 12 months of follow-up time, 55% of vaccinations occurred at ambulatory medical provider offices and 40% at pharmacies; among 2 doses recipients, 33% of vaccinations occurred at provider offices and 62% at pharmacies. Conclusion Among 50‒64-year-olds, 2-dose RZV series completion was ~70% within 6 months and 80% within 12 months of initiation. The findings were similar across two administrative claims databases. Availability of RZV at pharmacies has potentially helped to increase RZV 2nd dose completion rates. Disclosures All Authors: No reported disclosures

scholarly journals 19. Completion of Two-Dose Recombinant Zoster Vaccine Series in Adults 50 Years and Older

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S32-S33
Author(s):  
Hung-Fu Tseng ◽  
Lei Qian ◽  
Jun Wu ◽  
Yi Luo ◽  
Lina S Sy ◽  
...  
Keyword(s):  
Health Care ◽  
Influenza Vaccine ◽  
Zoster Vaccine ◽  
Kaiser Permanente ◽  
Factors Associated ◽  
Series Completion ◽  
Race Ethnicity ◽  
Recombinant Zoster Vaccine ◽  
Research Grant

Abstract Background In 2017, the Advisory Committee on Immunization Practices preferentially recommended adjuvanted recombinant zoster vaccine (RZV) for adults ≥ 50 years as a two-dose series 2–6 months apart.1 We evaluated two-dose RZV completion and factors associated with completion. Methods The study included Kaiser Permanente Southern California members ≥ 50 years who received an RZV dose during April-November 2018 and had continuous membership 12 months before to 9 months after the 1st RZV dose (RZV1). Completion was defined as receipt of the 2nd dose ≥4 weeks to 9 months after RZV1 (allowing a 3-month grace period). Characteristics including age at RZV1, sex, race/ethnicity, Medicaid status, neighborhood level income and education, distance from home to medical office, comorbidities, history of herpes zoster, health care utilization before and after RZV1, receipt of influenza vaccine, vaccination month (supply shortage proxy), concomitant vaccine, department administering RZV1, medical center, and medically attended local or systemic reaction, pain, or gout after RZV1 were compared between completers and non-completers. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) for factors associated with completion were estimated by multivariable logistic regression. Results Among 31,120 RZV1 recipients, 67.2% completed the series within 9 months. In adjusted analyses, higher completion was associated with White compared with Black or Hispanic race/ethnicity, higher neighborhood income and education, no chronic pulmonary disease, diabetes, or dementia, more outpatient visits and fewer emergency department visits before or after RZV1, no hospitalizations after RZV1, receipt of influenza vaccine, receipt of RZV1 in June-November rather than April-May 2018, no concomitant vaccine with RZV1, and receipt of RZV1 in Family Practice rather than Internal Medicine. Systemic reactions or pain after RZV1 was not associated with completion. Table 2. RZV Series Completion by Selected Characteristics During Follow-up of Members Aged ≥50 Years Who Received at Least One Dose of RZV at Kaiser Permanente Southern California in April-November 2018 Table 2. RZV Series Completion by Selected Characteristics During Follow-up of Members Aged ≥ 50 Years Who Received at Least One Dose of RZV at KPSC in April-November 2018 Figure 1. Factors Associated with RZV Series Completion of Members Aged ≥ 50 Years Who Received at Least One Dose of RZV at KPSC in April-November 2018 Conclusion Completion of RZV series appears moderate in the early phase of implementation. Despite similar accessibility in a health care system, completion varied by race/ethnicity, socioeconomic status, health status, and care seeking behavior, suggesting areas to target for improvement. Disclosures Hung-Fu Tseng, MPH, PhD, GlaxoSmithKlein (Research Grant or Support) Lei Qian, PhD, GlaxoSmithKlein (Research Grant or Support) Jun Wu, MD, MS, GlaxoSmithKlein (Research Grant or Support) Yi Luo, PhD, GlaxoSmithKlein (Research Grant or Support) Lina S. Sy, MPH, GlaxoSmithKlein (Research Grant or Support) Katia Bruxvoort, PhD, MPH, GlaxoSmithKlein (Research Grant or Support) Bradley Ackerson, MD, GlasoSmithKlein (Research Grant or Support)

scholarly journals Effectiveness of the recombinant zoster vaccine in adults aged 50 and older in the United States: a claims-based cohort study

2021 ◽  
Author(s):  
Yuwei Sun ◽  
Eric Kim ◽  
Christina L Kong ◽  
Benjamin F Arnold ◽  
Travis C Porco ◽  
...  
Keyword(s):  
Cohort Study ◽  
Herpes Zoster ◽  
Vaccine Coverage ◽  
The United States ◽  
Vaccine Effectiveness ◽  
Administrative Claims ◽  
Zoster Vaccine ◽  
Immunization Rates ◽  
History Of ◽  
Recombinant Zoster Vaccine

Abstract Background The recombinant zoster vaccine had over 90% efficacy in preventing herpes zoster in clinical trials. However, its effectiveness outside of a clinical trial setting has not been investigated. This study aimed to assess the effectiveness of the recombinant zoster vaccine in general practice. Methods A de-identified administrative claims database, the OptumLabs ® Data Warehouse, was used to conduct this retrospective cohort study to assess the effectiveness of the recombinant zoster vaccine against herpes zoster in non-immunocompromised, vaccine age-eligible individuals enrolled in the database for ≥365 days. Results A total of 4 769 819 adults were included in this study, with 173 745 (3.6%) adults receiving two valid doses of the recombinant zoster vaccine. The incidence rate of herpes zoster was 258.8 (95% CI: 230.0 to 289.4) cases per 100 000 person-years in vaccinated persons compared to 893.1 (95% CI: 886.2 to 900.0) in unvaccinated. Recombinant zoster vaccine effectiveness was 85.5% (95% CI: 83.5% to 87.3%) overall, with an effectiveness of 86.8% (95% CI: 84.6% to 88.7%) in individuals 50 to 79-years-old compared to 80.3% (95% CI: 75.1% to 84.3%) in individuals ages 80 and older. In patients with a history of live zoster vaccine within 5 years of study inclusion, vaccine effectiveness was 84.8% (95% CI: 75.3% to 90.7%). Conclusions Recombinant zoster vaccine effectiveness against herpes zoster was high in a real-world setting. Given the low vaccine coverage and high effectiveness, a major public health effort is needed to identify and address barriers to vaccination and increase immunization rates.

scholarly journals Patterns of Long-Term Prescription Opioid Use Among Older Adults in the United States: A Study of Medicare Administrative Claims Data

2020 ◽  
Vol 1;24 (1;1) ◽  
pp. 31-40
Keyword(s):  
Older Adults ◽  
Claims Data ◽  
The United States ◽  
Prescription Opioid ◽  
Administrative Claims ◽  
Medicare Beneficiaries ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Administrative Claims Data

BACKGROUND: Long-term opioid therapy was prescribed with increasing frequency over the past decade. However, factors surrounding long-term use of opioids in older adults remains poorly understood, probably because older people are not at the center stage of the national opioid crisis. OBJECTIVES: To estimate the annual utilization and trends in long-term opioid use among older adults in the United States. STUDY DESIGN: Retrospective cohort study. SETTING: Data from Medicare-enrolled older adults. METHODS: This study utilized a nationally representative sample of Medicare administrative claims data from the years 2012 to 2016 containing records of health care services for more than 2.3 million Medicare beneficiaries each year. Medicare beneficiaries who were 65 years of age or older and who were enrolled in Medicare Parts A, B, and D, but not Part C, for at least 10 months in a year were included in the study. We measured annual utilization and trends in new long-term opioid use episodes over 4 years (2013–2016). We examined claims records for the demographic characteristics of the eligible individuals and for the presence of chronic non-cancer pain (CNCP), cancer, and other comorbidities. RESULTS: From 2013 to 2016, administrative claims of approximately 2.3 million elderly Medicare beneficiaries were analyzed in each year with a majority of them being women (~56%) and white (~82%) with a mean age of approximately 75 years. The proportion of all eligible beneficiaries with at least one new opioid prescription increased from 6.64% in 2013, peaked at 10.32% in 2015, and then decreased to 8.14% in 2016. The proportion of individuals with long-term opioid use among those with a new opioid prescription was 12.40% in 2013 and 10.20% in 2016. Among new long-term opioid users, the proportion of beneficiaries with a cancer diagnosis during the study years increased from 13.30% in 2013 to 15.67% in 2016, and the proportion with CNCP decreased from 30.25% in 2013 to 27.36% in 2016. Across all years, long-term opioid use was consistently high in the Southern states followed by the Midwest region. LIMITATIONS: This study used Medicare fee-for-service administrative claims data to capture prescription fill patterns, which do not allow for the capture of individuals enrolled in Medicare Advantage plans, cash prescriptions, or for the evaluation of appropriateness of prescribing, or the actual use of medication. This study only examined long-term use episodes among patients who were defined as opioid-naive. Finally, estimates captured for 2016 could only utilize data from 9 months of the year to capture 90-day long-term-use episodes. CONCLUSIONS: Using a national sample of elderly Medicare beneficiaries, we observed that from 2013 to 2016 the use of new prescription opioids increased from 2013 to 2014 and peaked in 2015. The use of new long-term prescription opioids peaked in 2014 and started to decrease from 2015 and 2016. Future research needs to evaluate the impact of the changes in new and long-term prescription opioid use on population health outcomes. KEY WORDS: Long-term, opioids, older adults, trends, Medicare, chronic non-cancer pain, cancer, cohort study

Impact of USPSTF recommendations on utilization of PSA screening in Medicare beneficiaries.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 166-166
Author(s):  
Rahul Ramesh Khairnar ◽  
Mark Mishra ◽  
Ebere Onukwugha
Keyword(s):  
Task Force ◽  
Specific Antigen ◽  
Age Groups ◽  
The United States ◽  
Study Cohort ◽  
Administrative Claims ◽  
Medicare Beneficiaries ◽  
Psa Screening ◽  
Medicare Population ◽  
The Impact

166 Background: Previous studies assessing the impact of the United States Preventive Services Task Force (USPSTF) recommendations on utilization of prostate-specific antigen (PSA) screening have not investigated longer-term impacts of the 2008 recommendations nor have they investigated the impact of the 2012 recommendations in the Medicare population. The study aim was to evaluate change in utilization of PSA screening, post USPSTF recommendations of 2008 and 2012, and to assess trends and determinants of receipt of PSA screening in the Medicare population. Methods: This retrospective study of male Medicare beneficiaries utilized Medicare Current Beneficiary Survey (MCBS) data and linked administrative claims from 2006-2013. Beneficiaries aged ≥65 years, with continuous enrollment in Parts A and B for each year they were surveyed were included in the study cohort. Beneficiaries with self-reported or claims-based diagnosis of prostate cancer were excluded. Beneficiaries with Medicare eligibility due to end stage renal disease or disability were also excluded. The primary outcome was receipt of PSA screening. Other measures include age groups (65-74 and ≥75), time periods (pre- and post-2008 and 2012 recommendations), and sociodemographic variables. Results: The study cohort consisted of 11,028 beneficiaries, who were predominantly white (87.56%), married (69.25%), and unemployed (84.4%); 52.21% beneficiaries were aged ≥75. Declining utilization trends for PSA screening were observed only in men aged ≥75 after 2008 recommendations and in both age groups after 2012 recommendations. The odds of receiving PSA screening declined by 17% percent in men aged ≥75 after the 2008 recommendations and by 29% in men aged ≥65 after the 2012 recommendations. Conclusions: The USPSTF recommendations of 2008 and 2012 against PSA screening were associated with declines in utilization of PSA screening during the study period. USPSTF recommendations play a significant role in affecting utilization patterns of health services. Future studies should evaluate if the proposed 2017 update to these recommendations advocating shared decision-making for PSA screening in men aged 55-69 increase utilization in this age-group.

Epidemiology and mortality of metastatic castration-resistant prostate cancer (mCRPC) in a managed care population in the United States.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e13592-e13592 ◽  
Author(s):  
Katrine Wallace ◽  
Adrienne Landsteiner ◽  
Scott Bunner ◽  
Nicole Engel-Nitz ◽  
Amy Luckenbaugh
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Index Date ◽  
The United States ◽  
Baseline Period ◽  
Mortality Data ◽  
Administrative Claims ◽  
Claims Database ◽  
Study Population

e13592 Background: To date, there has been a paucity of information in the literature describing the epidemiology of mCRPC within the prostate cancer population. We present a real-world data study describing characteristics and mortality of patients with mCRPC within an administrative claims database of an insured population within the United States. Methods: In an administrative claims database of ≈18,000,000 covered lives, adult male patients were included if they had ≥1 claim for prostate cancer (ICD-9: 185 or 233.4; ICD-10: C61 or D075), underwent pharmacologic or surgical castration, and had a code for metastatic disease during the identification period (January 1, 2008–March 31, 2018). The index date was the first metastatic claim; 6 months of continuous enrollment (CE) prior to (baseline period) and after (follow-up period) the index date was required. Patients with metastatic claims in the baseline period were excluded. Patients were followed until the earliest of: death (unless prior to the 6-month CE), end of study period, or disenrollment. A claims-based algorithm was employed to identify locally advanced and distant mCRPC patients in the prostate cancer study population. Mortality data were sourced from the Social Security Administration Medicare data, and a claims algorithm. Results: 343,089 patients were identified with a claim for prostate cancer; of those, 3690 mCRPC cases (1.1%) were identified using the claims-based algorithm and met the study inclusion criteria. Median age was 75 years. Insurance type included commercial plans (27%) and Medicare (73%). Castration type included pharmacologic (99%) and surgical (1%). First claims for metastases were most commonly in the bone (65%) or lymph nodes (15%), with 20% in other sites. The study population averaged a Charlson comorbidity index score of 3.05 at baseline, with 16% of patients receiving a score of ≥5. The most common baseline comorbidities were hypertension (67%), urinary disease (58%), dyslipidemia (52%), and cardiac disease (45%). Median follow-up time among the mCRPC group was 538 days, during which 1834 deaths occurred; 50% of the population experienced mortality during the study period. Conclusions: This study provides valuable insights into the epidemiology, clinical characteristics, prevalence rate, and mortality of patients with mCRPC. Given the high mortality proportion of this disease, the development of novel therapies to prolong life in patients with mCRPC is warranted.

scholarly journals Frequency of Early Refills for Opioids in the United States

Pain Medicine ◽  
2020 ◽  
Vol 21 (9) ◽  
pp. 1818-1824
Author(s):  
David M Kern ◽  
M Soledad Cepeda ◽  
Maribel Salas ◽  
Syd Phillips ◽  
Matthew H Secrest ◽  
...  
Keyword(s):  
Patient Characteristics ◽  
Immediate Release ◽  
The United States ◽  
Prescription Opioid ◽  
Opioid Prescription ◽  
National Drug ◽  
One Year ◽  
Long Acting ◽  
Opioid Users

Abstract Objective Refilling an opioid prescription early is an important risk factor of prescription opioid abuse and misuse; we aimed to understand the scope of this behavior. This study was conducted to quantify the prevalence and distribution of early refills among patients prescribed opioids. Methods We conducted a retrospective cohort study utilizing dispensed prescription records. Patients filling one or more prescription opioids were identified and followed for one year. Early refills were defined as having a second prescription filled ≥15% early relative to the days’ supply of the previous prescription for the same opioid (according to the National Drug Code [NDC]). The distribution of the number of early refills and patient characteristics were assessed. Results A total of 60.6 million patients met the study criteria; 28.8% had two or more opioid prescriptions for the same opioid during follow-up. Less than 3% of all patients receiving an opioid had an early refill. Approximately 10% of those with two or more opioid prescriptions for the same drug had an early refill. For patients with multiple fills (N = 1.5 million with extended-release long-acting [ER/LA] opioids; N = 17.1 million with immediate-release short-acting [IR/SA] opioids), early refills were more common among patients with an ER/LA opioid (18.5%) compared with an IR/SA opioid (8.7%). Three-quarters of patients with an early refill had only one (70.9% and 78.4% for ER/LA and IR/SA, respectively). Conclusion Refilling an opioid prescription with the same opioid early is an infrequent behavior within all opioid users, but more common in ER/LA users. Patients who refilled early tended to do so just once.

scholarly journals Cost-effectiveness of an adjuvanted recombinant zoster vaccine in older adults in the United States who have been previously vaccinated with zoster vaccine live

2019 ◽  
Vol 15 (4) ◽  
pp. 765-771 ◽  
Author(s):  
Desmond Curran ◽  
Brandon J. Patterson ◽  
Desiree Van Oorschot ◽  
Philip O. Buck ◽  
Justin Carrico ◽  
...  
Keyword(s):  
United States ◽  
Older Adults ◽  
Cost Effectiveness ◽  
The United States ◽  
Zoster Vaccine ◽  
Recombinant Zoster Vaccine

Geographic Variation in Use of Vestibular Testing among Medicare Beneficiaries

2016 ◽  
Vol 156 (2) ◽  
pp. 312-320 ◽  
Author(s):  
Meredith E. Adams ◽  
Schelomo Marmor ◽  
Bevan Yueh ◽  
Robert L. Kane
Keyword(s):  
Geographic Variation ◽  
The United States ◽  
Geographic Region ◽  
Spontaneous Nystagmus ◽  
Administrative Claims ◽  
Medicare Beneficiaries ◽  
Cross Sectional ◽  
Balance Disorders ◽  
Patterns Of Use ◽  
Vestibular Testing

Objective There is a lack of consensus regarding the indications for vestibular testing in the evaluation of dizziness and balance disorders. Geographic variation in health services utilization is associated with lack of consensus. To understand the variation in current practice, we investigated the patterns of use of vestibular testing and diagnosis codes for dizziness and balance disorders among individuals ≥65 years of age across different regions of the United States. Study Design Cross-sectional study. Setting Medicare administrative claims data. Subjects and Methods Using the Summarized Denominator file, a sample of the US population linked to the Surveillance, Epidemiology, and End Results (SEER)–Medicare files (years 2000-2010), we identified persons who were ≥65 years of age. We used multivariable analyses to determine the factors associated with vestibular testing and diagnoses. Results Of the 231,984 eligible Medicare beneficiaries, 27% were diagnosed with dizziness and balance disorders. Patterns of use of vestibular tests (eye movement recording for spontaneous nystagmus, caloric testing, and rotary chair testing) varied significantly by geographic region. Rotary chair test utilization varied most. We found significant geographic variation in vestibular testing and diagnoses after controlling for age, sex, race, Medicaid participation, and rurality. Conclusions There may be opportunities to improve the consistency and efficiency of care for dizziness and balance disorders. It will be important to define appropriate levels of vestibular diagnostic testing and which tests add sufficient value to justify the costs. Further work is needed to better characterize the causes and consequences of variation in vestibular test utilization.

Safety of Recombinant Zoster Vaccine: a Retrospective Study of 622 Rheumatology Patients

Rheumatology ◽  
2021 ◽  
Author(s):  
Tiphaine Lenfant ◽  
Yuxuan Jin ◽  
Elizabeth Kirchner ◽  
Rula A Hajj-Ali ◽  
Leonard H Calabrese ◽  
...  
Keyword(s):  
Inflammatory Diseases ◽  
Cox Model ◽  
Patient Portal ◽  
Single Center ◽  
Zoster Vaccine ◽  
Treatment Change ◽  
Immune Mediated ◽  
Recombinant Zoster Vaccine ◽  
Insight Into

Abstract Objectives To provide insight into the safety of Recombinant Zoster Vaccine (RZV) in patients with Immune-Mediated Inflammatory Diseases (IMID). Methods Patients who received RZV in a single center Rheumatology Department were retrospectively included. An IMID flare was defined as a) a documentation of flare in the office notes or patient portal communication or b) new prednisone prescription, in the 12 weeks after each dose. Results Six-hundred twenty-two patients were included (67% female, median age 67 years), 8.5% of them experienced AEs and HZ incidence was 0.6% after median follow-up of 36 weeks. Of 359 IMID patients: 88 had RA (25%), 50 vasculitis (14%), 29 PMR (8%). At vaccination, 35% were on glucocorticoids (GC). Fifty-nine patients (16%) experienced a flare, 18 flares occurred in temporal relation to a treatment change (31%). RA patients had the highest flare rate (n = 21, 24%), 25% of patients who flared required adjustment of immunosuppression. In a multivariate analysis, use of GC at time of vaccination was associated with flare after vaccination (OR 2.31 [1.3-4.1], p = 0.004). A time-to-flare survival analysis (Cox-model) showed that GC was a significant predictor of IMID flare after first RZV dose (HR 2.4 [1.3-4.5], p = 0.0039) and that a flare after the first dose was associated with flaring after the second RZV dose (HR 3.9 [1.7-9], p = 0.0015). Conclusion RZV administration in patients with IMIDs was generally well-tolerated, though mild flares were not uncommon in the first 12 weeks after vaccination. These data may provide useful information for patient education when considering RZV administration.

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