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Owusu-Edusei K, Favre-Bulle A, Tsoumani E, Mutschler T, Cossrow N. Evaluating the health and economic outcomes of a PCV15 vaccination program for adults aged 65 years-and-above in Switzerland. Vaccine 2024; 42:3239-3246. [PMID: 38609806 DOI: 10.1016/j.vaccine.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/24/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To assess the health and economic outcomes of a PCV13 or PCV15 age-based (65 years-and-above) vaccination program in Switzerland. INTERVENTIONS The three vaccination strategies examined were:Target population: All adults aged 65 years-and-above. Perspective(s): Switzerland health care payer. TIME HORIZON 35 years. Discount rate: 3.0%. Costing year: 2023 Swiss Francs (CHF). STUDY DESIGN A static Markov state-transition model. DATA SOURCES Published literature and publicly available databases or reports. OUTCOME MEASURES Pneumococcal diseases (PD) i.e., invasive pneumococcal diseases (IPD) and non-bacteremic pneumococcal pneumonia (NBPP); total quality-adjusted life-years (QALYs), total costs and incremental cost-effectiveness ratios (CHF/QALY gained). RESULTS Using an assumed coverage of 60%, the PCV15 strategy prevented a substantially higher number of cases/deaths than the PCV13 strategy when compared to the No vaccination strategy (1,078 IPD; 21,155 NBPP; 493 deaths). The overall total QALYs were 10,364,620 (PCV15), 10,364,070 (PCV13), and 10,362,490 (no vaccination). The associated overall total costs were CHF 741,949,814 (PCV15), CHF 756,051,954 (PCV13) and CHF 698,329,579 (no vaccination). Thus, the PCV13 strategy was strongly dominated by the PCV15 strategy. The ICER of the PCV15 strategy (vs. no vaccination) was CHF 20,479/QALY gained. In two scenario analyses where the vaccine effectiveness for serotype 3 were reduced (75% to 39.3% for IPD; 45% to 23.6% for NBPP) and NBPP incidence was increased (from 1,346 to 1,636/100,000), the resulting ICERs were CHF 29,432 and CHF 13,700/QALY gained, respectively. The deterministic and probabilistic sensitivity analyses demonstrated the robustness of the qualitative results-the estimated ICERs for the PCV15 strategy (vs. No vaccination) were all below CHF 30,000/QALYs gained. CONCLUSIONS These results demonstrate that using PCV15 among adults aged 65 years-and-above can prevent a substantial number of PD cases and deaths while remaining cost-effective over a range of inputs and scenarios.
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Affiliation(s)
- Kwame Owusu-Edusei
- Biostatistics & Research Decision Sciences (BARDS), Merck & Co., Inc., Rahway, NJ, USA.
| | | | - Eleana Tsoumani
- Center for Observational and Real-World Evidence, MSD, Athens, Greece
| | | | - Nicole Cossrow
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Rahway, NJ, USA
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Diakite I, Martins B, Owusu-Edusei K, Palmer C, Patterson-Lomba O, Gomez-Lievano A, Zion A, Simpson R, Daniels V, Elbasha E. Structured Literature Review to Identify Human Papillomavirus's Natural History Parameters for Dynamic Population Models of Vaccine Impacts. Infect Dis Ther 2024:10.1007/s40121-024-00952-z. [PMID: 38589763 DOI: 10.1007/s40121-024-00952-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
Human papillomavirus (HPV) is a common sexually transmitted virus that can cause cervical cancer and other diseases. Dynamic transmission models (DTMs) have been developed to evaluate the health and economic impacts of HPV vaccination. These models typically include many parameters, such as natural history of the disease, transmission, demographic, behavioral, and screening. To ensure the accuracy of DTM projections, it is important to parameterize them with the best available evidence. This study aimed to identify and synthesize data needed to parametrize DTMs on the natural history of HPV infection and related diseases. Parameters describing data of interest were grouped by their anatomical location (genital warts, recurrent respiratory papillomatosis, and cervical, anal, vaginal, vulvar, head and neck, and penile cancers), and natural history (progression, regression, death, cure, recurrence, detection), and were identified through a systematic literature review (SLR) and complementary targeted literature reviews (TLRs). The extracted data were then synthesized by pooling parameter values across publications, and summarized using the range of values across studies reporting each parameter and the median value from the most relevant study. Data were extracted and synthesized from 223 studies identified in the SLR and TLRs. Parameters frequently reported pertained to cervical cancer outcomes, while data for other anatomical locations were less available. The synthesis of the data provides a large volume of parameter values to inform HPV DTMs, such as annual progression rates from cervical intraepithelial neoplasia (CIN) 1 to CIN 2+ (median of highest quality estimate 0.0836), CIN 2 to CIN 3+ (0.0418), carcinoma in situ (CIS) 2 to local cancer+ (0.0396), and regional to distant cancer (0.0474). Our findings suggest that while there is a large body of evidence on cervical cancer, parameter values featured substantial heterogeneity across studies, and further studies are needed to better parametrize the non-cervical components of HPV DTMs.
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Affiliation(s)
- Ibrahim Diakite
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, 07065, USA.
- Merck & Co., Inc. Biostatistics and Research Decision Sciences (BARDS), Health Economic and Decision Sciences (HEDS), Vaccines, WP 37A-150 770 Sumneytown Pike, 1st Floor, West Point, PA, 19486, USA.
| | - Bruno Martins
- Analysis Group, Inc, 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA
| | - Kwame Owusu-Edusei
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, 07065, USA
| | - Cody Palmer
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, 07065, USA
| | | | | | - Abigail Zion
- Analysis Group, Inc, 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA
| | - Ryan Simpson
- Analysis Group, Inc, 111 Huntington Avenue, 14th Floor, Boston, MA, 02199, USA
| | - Vincent Daniels
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, 07065, USA
| | - Elamin Elbasha
- Health Economic and Decision Sciences, Merck & Co., Inc., Rahway, NJ, 07065, USA
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Restivo V, Baldo V, Sticchi L, Senese F, Prandi GM, Pronk L, Owusu-Edusei K, Johnson KD, Ignacio T. Cost-Effectiveness of Pneumococcal Vaccination in Adults in Italy: Comparing New Alternatives and Exploring the Role of GMT Ratios in Informing Vaccine Effectiveness. Vaccines (Basel) 2023; 11:1253. [PMID: 37515068 PMCID: PMC10384960 DOI: 10.3390/vaccines11071253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
In Italy, a sequential pneumococcal vaccination with conjugate vaccine (PCV) and polysaccharide vaccine (PPSV23) is recommended for individuals aged ≥ 65 years and those at risk for pneumococcal disease (PD) aged ≥ 6 years. The aim of this study was to assess the cost-effectiveness of the new vaccines, i.e., approved 15-valent and 20-valent PCVs. A published Markov model was adapted to evaluate the lifetime cost-effectiveness of vaccination with PCV15 + PPSV23 versus PCV13 + PPSV23, PCV20 alone, PCV20 + PPSV23, and No Vaccination. Simulated cohorts representing the Italian population, including individuals aged ≥ 65 years, those at risk aged 50-100 years, and those deemed high risk aged 18-100 years were assessed. Outcomes were accrued in terms of incremental PD cases, costs, quality-adjusted life years, life years, and the cost-utility ratio relative to PCV13 + PPSV23. The conservative base case analysis, including vaccine efficacy based on PCV13 data, showed that sequential vaccination with PCV15 or PCV20 in combination with PPSV23 is preferred over sequential vaccination with PCV13 + PPSV23. Especially in the high-risk group, PCV15 + PPSV23 sequential vaccination was dominant over No Vaccination and resulted in an ICUR of €3605 per QALY gained. Including PCV20 + PPSV23 into the comparison resulted in the domination of the PCV15 + PPSV23 and No Vaccination strategies. Additionally, explorative analysis, including the geometric mean titer (GMT) informed vaccine effectiveness (VE) was performed. In the low-risk and high-risk groups, the results of the GMT scenarios showed PCV15 + PPSV23 to be dominant over the other sequential vaccines. These findings suggest that if real-world studies would confirm a difference in vaccine effectiveness of PCV15 and PCV20 versus PCV13 based on GMT ratios, PCV15 + PPSV23 could prove a highly immunogenic and effective vaccination regime for the Italian adult population.
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Affiliation(s)
- Vincenzo Restivo
- Department of Health Promotion, Mother-Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90127 Palermo, Italy
| | - Vincenzo Baldo
- Hygiene and Public Health Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35131 Padua, Italy
| | - Laura Sticchi
- Department of Health Sciences, University of Genoa, 16100 Genoa, Italy
| | | | | | - Linde Pronk
- OPEN Health Group, 3068 AV Rotterdam, The Netherlands
| | | | | | - Tim Ignacio
- OPEN Health Group, 3068 AV Rotterdam, The Netherlands
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Huang M, Hu T, Weaver J, Owusu-Edusei K, Elbasha E. Cost-Effectiveness Analysis of Routine Use of 15-Valent Pneumococcal Conjugate Vaccine in the US Pediatric Population. Vaccines (Basel) 2023; 11:vaccines11010135. [PMID: 36679980 PMCID: PMC9861214 DOI: 10.3390/vaccines11010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/15/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023] Open
Abstract
This study evaluated the clinical and economic impact of routine pediatric vaccination with the 15-valent pneumococcal conjugate vaccine (PCV15, V114) compared with the 13-valent PCV (PCV13) from a societal perspective in the United States (US). A Markov decision-analytic model was constructed to estimate the outcomes for the entire US population over a 100-year time horizon. The model estimated the impact of V114 versus PCV13 on pneumococcal disease (PD) incidence, post meningitis sequalae, and deaths, taking herd immunity effects into account. V114 effectiveness was extrapolated from the observed PCV13 data and PCV7 clinical trials. Costs (2021$) included vaccine acquisition and administration costs, direct medical costs for PD treatment, direct non-medical costs, and indirect costs, and were discounted at 3% per year. In the base case, V114 prevented 185,711 additional invasive pneumococcal disease, 987,727 all-cause pneumonia, and 11.2 million pneumococcal acute otitis media cases, compared with PCV13. This led to expected gains of 90,026 life years and 96,056 quality-adjusted life years with a total saving of $10.8 billion. Sensitivity analysis showed consistent results over plausible values of key model inputs and assumptions. The findings suggest that V114 is a cost-saving option compared to PCV13 in the routine pediatric vaccination program.
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Affiliation(s)
- Min Huang
- Correspondence: ; Tel.: +1 215-652-5974
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Huang M, Hu T, Weaver J, Owusu-Edusei K, Elbasha E. 578. Cost-effectiveness of Infant Vaccination with PCV15 Compared to PCV13 in the United States. Open Forum Infect Dis 2022. [DOI: 10.1093/ofid/ofac492.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract
Background
Streptococcus pneumoniae is a major cause of mortality and morbidity in young children. The 13-valent pneumococcal conjugate vaccine (PCV13) has been in routine use in children in the United States (US) since 2010. An investigational 15-valent vaccine (PCV15) that protects against two additional serotypes is currently under review by the FDA. This study aimed to evaluate the clinical and economic impact of routine infant vaccination with PCV15 compared with PCV13 from a US societal perspective.
Methods
A Markov decision-analytic model was developed to estimate the impact of PCV15 vs. PCV13 on pneumococcal disease incidence, post meningitis sequalae, and deaths. The model followed the entire US population over a 100-year time horizon, taking herd immunity effects into account. Each vaccination program comprised 3 primary doses and one booster for the new birth cohorts. Model inputs were obtained from the published literature, online databases, and unpublished data. PCV15 effectiveness was extrapolated from observed PCV13 data and PCV7 clinical trials. Costs (in 2021 USD) and quality-adjusted life years (QALYs) were discounted at 3% per year. Because the price for PCV15 in the pediatric indication is currently unknown, an analysis was conducted to determine the threshold price, which was defined as the maximum price for PCV15 to remain cost-saving. A series of sensitivity analyses were performed to test the robustness of model results.
Results
The base case results projected that PCV15 prevented 185,711 more invasive pneumococcal disease cases, 987,727 all-cause pneumonia cases and 11,151,473 pneumococcal acute otitis media and tube-replacement cases compared with PCV13. This resulted in an expected gain of 96,056 QALYs and total reduction of $7 billion in direct medical costs (excluding vaccine costs), and $4 billion in direct non-medical and indirect costs in the US population over the 100-year time horizon. The threshold price per dose for PCV15 was $28 higher than PCV13’s price. Sensitivity analyses showed the results to be robust over plausible values of key model inputs and assumptions.
Conclusion
Infant vaccination with PCV15 is projected to provide both clinical benefits and cost-savings compared with PCV13.
Disclosures
Min Huang, PhD, Merck & Co., Inc.: full-time employee Tianyan Hu, Ph.D., Merck & Co., Inc.: full time employee Jessica Weaver, PhD, MPH, Merck & Co., Inc.: Employee Kwame Owusu-Edusei, Ph.D., Merck & Co., Inc.: full time employee Elamin Elbasha, Ph.D., Merck & Co., Inc.: full time employee.
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Affiliation(s)
- Min Huang
- Merck & Co. , Inc., Rahway, New Jersey
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Mohanty S, Hu T, Yang G, Khan TK, Owusu-Edusei K, Sukarom I. Health and economic burden associated with 15-valent pneumococcal conjugate vaccine serotypes in Korea and Hong Kong. Hum Vaccin Immunother 2022; 18:2046433. [PMID: 35420975 PMCID: PMC9196648 DOI: 10.1080/21645515.2022.2046433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Use of pneumococcal conjugate vaccines (PCVs) has greatly reduced the incidence of invasive pneumococcal disease (IPD). V114 (VAXNEUVANCE™, Merck Sharp & Dohme Corp. a subsidiary of Merck & Co. Inc. Kenilworth, NJ, USA) is a 15-valent PCV currently approved in adults in the United States, containing the 13 serotypes in licensed PCV13 and 2 additional serotypes (22F and 33F) which are important contributors to residual pneumococcal disease. This study quantified the health and economic burden of IPD attributable to V114 serotypes in hypothetical birth cohorts from Korea and Hong Kong. A Markov model was used to estimate the case numbers and costs of IPD in unvaccinated birth cohorts over 20 years. The model was applied to 3 scenarios in Korea (pre-PCV7, pre-PCV13, and post-PCV13) and to 2 scenarios in Hong Kong (pre-PCV7 and post-PCV13). For Korea, the model predicted 62, 26, and 8 IPD cases attributable to V114 serotypes in the pre-PCV7, pre-PCV13, and post-PCV13 scenarios, respectively. Costs of V114-type IPD fell from $1.691 million pre-PCV7 to $.212 million post-PCV13. For Hong Kong, the model estimated 62 V114-associated IPD cases in the pre-PCV7 scenario and 46 in the post-PCV13 scenario. Costs attributed to all V114 serotypes were $2.322 million and $1.726 million in the pre-PCV7 and post-PCV13 periods, respectively. Vaccine-type serotypes are predicted to cause continuing morbidity and cost in Korea (19A) and Hong Kong (3 and 19A). New pediatric pneumococcal vaccines must continue to protect against serotypes in licensed vaccines to maintain disease reduction, while extending coverage to non-vaccine serotypes.
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Affiliation(s)
- Salini Mohanty
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
| | - Tianyan Hu
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - Tsz K Khan
- Global Medical and Scientific Affairs, MSD, Hong Kong, China
| | - Kwame Owusu-Edusei
- Biostatistics & Research Decision Sciences (BARDS), Merck & Co., Inc., Kenilworth, NJ, USA
| | - Isaya Sukarom
- Center for Observational and Real-World Evidence (CORE), MSD Thailand, Bangkok, Thailand
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Owusu-Edusei K, Palmer C, Ovcinnikova O, Favato G, Daniels V. Assessing the Health and Economic Outcomes of a 9-Valent HPV Vaccination Program in the United Kingdom. J Health Econ Outcomes Res 2022; 9:140-150. [PMID: 35795155 PMCID: PMC9170517 DOI: 10.36469/001c.34721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
Background: The United Kingdom (UK) switched from using the 4-valent human papillomavirus (HPV) vaccine (Gardasil®) to the 9-valent vaccine (Gardasil 9®) in 2021. Objective: To estimate and compare the health and economic outcomes of 2 HPV vaccination programs in the UK targeting girls and boys aged 12-13 years from the perspective of the UK National Health Service. The 2 vaccination strategies were (1) universal vaccination 4-valent (UV4V), using the 4-valent HPV vaccine (4vHPV), and (2) universal vaccination 9-valent (UV9V), using the 9-valent HPV vaccine (9vHPV). Methods: A deterministic heterosexual compartmental disease transmission model was used to track health and economic outcomes over a 100-year time horizon. Outcomes were discounted at an annual rate of 3.5% and 1.5%. All costs were adjusted to 2020 British pounds (£). Health outcomes were measured in quality-adjusted life-years (QALYs), and the summary results were presented as incremental cost-effectiveness ratios (£/QALY gained) when comparing UV4V with UV9V. Results: Using the same vaccine coverage for both programs, the total cumulative cases of HPV-related health outcomes tracked over the 100-year horizon indicated that the relative number of cases averted (UV9V vs UV4V) ranged from 4% (anal male cancers and deaths) to 56% (cervical intraepithelial neoplasia [CIN1]). Assuming that 9vHPV cost £15.18 more than 4vHPV (a cost differential based on discounted list prices), the estimated incremental cost-effectiveness ratio was £8600/QALY gained when discounted at 3.5%, and £3300/QALY gained when discounted at 1.5%. The estimated incremental cost-effectiveness ratios from the sensitivity analyses remained <£28000/QALY over a wide range of parameter inputs and demonstrated that disease utilities, discount rate, and vaccine efficacy were the 3 most influential parameters. Discussion: Consistent with other published studies, the results from this study found that the 9vHPV vaccine prevented a substantial number of cases when compared with the 4vHPV vaccine and was highly cost-effective. Conclusions: These results demonstrate that replacing universal 4vHPV with 9vHPV can prevent a substantial additional number of HPV-related cases/deaths (in both women and men) and remain cost-effective over a range of 9vHPV price premiums.
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Owusu-Edusei K, Deb A, Johnson KD. Correction to: Estimates of the Health and Economic Burden of Pneumococcal Infections Attributable to the 15-Valent Pneumococcal Conjugate Vaccine Serotypes in the USA. Infect Dis Ther 2022; 11:1001. [PMID: 35249201 PMCID: PMC9124261 DOI: 10.1007/s40121-022-00613-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Kwame Owusu-Edusei
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA.
| | - Arijita Deb
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
| | - Kelly D Johnson
- Center for Observational and Real-World Evidence (CORE), Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ, 07033, USA
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Deb A, Guggisberg P, Mutschler T, Owusu-Edusei K, Bencina G, Johnson KD, Ignacio T, Mathijssen D, Qendri V. Cost-effectiveness of the 15-valent pneumococcal conjugate vaccine for high-risk adults in Switzerland. Expert Rev Vaccines 2022; 21:711-722. [PMID: 35220875 DOI: 10.1080/14760584.2022.2046468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND : Vaccination against pneumococcal disease (PD) has shown a favourable cost-effectiveness profile for national immunization programs in multiple countries. While vaccination efforts have concentrated on children, many adults with underlying illnesses face elevated risks of PD and death. A 15-valent pneumococcal conjugate vaccine (V114) is currently available that offers protection against 15 different serotypes and can be used in adults. RESEARCH DESIGN AND METHODS : We examined the cost-effectiveness of V114 vaccination in high-risk adults, aged 18+, in Switzerland. To this end, a Markov model was constructed estimating the lifetime direct medical costs and clinical effectiveness of V114 vaccination on invasive pneumococcal disease (IPD) and non-bacteremic pneumococcal pneumonia (NBPP) among high-risk adults. RESULTS : Considering 60% vaccine uptake and direct effects of vaccination, in total 760 IPD and 4,396 NBPP in- and outpatient cases could be prevented. Vaccinating high-risk adults with V114 led to CHF 37.4 million additional vaccination costs but saved CHF 14.4 million of medical treatment costs. V114 vaccination produced a gain of 2,095 QALYs and 6,320 LYs compared with no vaccination, leading to incremental cost-effectiveness ratios of CHF 17,866/QALY and CHF 15,616/QALY gained from a health care payer and societal perspective, respectively. Conclusions: This evidence justifies the implementation of V114 vaccination among high-risk adults in Switzerland.
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Affiliation(s)
- Arijita Deb
- CORE, Merck & Co., Inc., Kenilworth, NJ, USA
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Hu T, Weiss T, Bencina G, Owusu-Edusei K, Petigara T. Health and economic burden of invasive pneumococcal disease associated with 15-valent pneumococcal conjugate vaccine serotypes in children across eight European countries. J Med Econ 2021; 24:1098-1107. [PMID: 34461796 DOI: 10.1080/13696998.2021.1970975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIMS V114, a 15-valent pneumococcal conjugate vaccine (PCV15) currently approved in adults in the US, contains the 13 S. pneumoniae serotypes in PCV13 and two additional serotypes, 22 F and 33 F, which are important contributors to residual PD. This study quantified the health and economic burden of pediatric invasive pneumococcal disease (IPD) associated with V114 serotypes in eight countries in Europe. MATERIALS AND METHODS A Markov model estimated V114-type IPD cases and costs in hypothetical unvaccinated birth cohorts from Denmark, France, Germany, Italy, Norway, Spain, Switzerland, and the UK over 20 years. Inputs were obtained from published literature. IPD cases and costs were calculated for three time periods using time-specific epidemiological data: (a) pre-PCV7; (b) pre-PCV13; and (c) post-PCV13. Costs were estimated from a societal perspective (2018 Euros) and discounted at 3%. RESULTS The model estimated that 4,649 IPD cases in the pre-PCV7 period, 3,248 cases in the pre-PCV13 period, and 958 cases in the post-PCV13 period were attributable to V114 serotypes. Total discounted costs associated with V114 serotypes were €109.1 million (pre-PCV7 period), €65.7 million (pre-PCV13 period), and €18.7 million (post-PCV13 period). LIMITATIONS Post-meningitis sequelae, acute otitis media, and non-bacteremic pneumonia were not considered. Direct non-medical costs were not included. Conclusions on effectiveness of V114 or added value over existing infant vaccination programs cannot be drawn. CONCLUSIONS IPD cases and costs were estimated in hypothetical birth cohorts in eight European countries followed for 20 years during three time periods. Serotypes included in V114 were associated with significant morbidity and costs in pre-PCV7, pre-PCV13, and post-PCV13 periods. Future pediatric pneumococcal vaccines should maintain protection against serotypes in licensed vaccines while extending coverage to additional serotypes to ensure reductions in IPD burden are maintained.
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Affiliation(s)
- Tianyan Hu
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Thomas Weiss
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | | | - Kwame Owusu-Edusei
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Tanaz Petigara
- Center for Observational and Real-World Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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Abstract
Although the incidence of invasive pneumococcal disease (IPD) and acute otitis media (AOM) in young children has decreased since the introduction of pneumococcal conjugate vaccines (PCVs), the subsequent emergence of non-vaccine Streptococcus pneumoniae serotypes and the persistence of certain vaccine serotypes both contribute to substantial residual pneumococcal disease. There is a need for the development of new pneumococcal vaccines to address the clinical and economic burden presented by emerging non-vaccine serotypes, while maintaining suppression of serotypes in existing vaccines. To assess the full value of next-generation vaccines, public health evaluations must consider epidemiological and economic data across all vaccine serotypes, including those included in existing vaccines and those unique to the new product. This is supported by two recent analyses that estimated the health and economic burden of IPD (in the United States and Europe) and AOM (in the United States only) associated with the serotypes in V114, a 15-valent pneumococcal conjugate vaccine (PCV15), which contains all serotypes in the licensed 13-valent pneumococcal conjugate vaccine (PCV13) as well as the unique serotypes 22 F and 33 F and was recently approved for use in adults in the US. The analyses demonstrated considerable health and economic burden associated with PCV13 serotypes, as well as increasing burden associated with serotypes 22 F and 33 F. In addition to addressing the burden of non-vaccine serotypes, ability to maintain or improve protection against disease caused by serotypes in existing vaccines will be an important consideration for decision makers.
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Affiliation(s)
- Tianyan Hu
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Kenilworth, NJ, USA
| | - Thomas Weiss
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Kenilworth, NJ, USA
| | | | - Kwame Owusu-Edusei
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Kenilworth, NJ, USA
| | - Tanaz Petigara
- Center for Observational and Real-World Evidence, Merck & Co., Inc, Kenilworth, NJ, USA
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Abstract
AIMS V114 is an investigational 15-valent pneumococcal conjugate vaccine (PCV) containing the 13 Streptococcus pneumoniae serotypes in 13-valent PCV (PCV13) plus two additional serotypes. This study quantified the health and economic burden of invasive pneumococcal disease (IPD) and acute otitis media (AOM) caused by V114 types among children in the United States. MATERIALS AND METHODS A Markov model estimated the number of V114-type IPD and AOM cases and costs in a hypothetical, unvaccinated US birth cohort over 20 years. Three time periods were analyzed using time-specific epidemiological data to determine the number of IPD and AOM cases associated with all 15 serotypes in V114. The time periods were: (1) pre-PCV7 (1999); (2) pre-PCV13 (2009); (3) post-PCV13 (2017). Costs were estimated from a societal perspective (2018 US dollars) and discounted at 3%. RESULTS The model estimated 18,983 IPD cases and 5.4 million AOM cases associated with V114 serotypes pre-PCV7, 4,697 IPD cases and 3.0 million AOM cases pre-PCV13, and 948 IPD cases and 0.2 million AOM cases post-PCV13. Total discounted costs associated with V114 serotypes were $1.7 billion pre-PCV7, $730 million pre-PCV13, and $75 million US dollars post-PCV13. LIMITATIONS Post-meningitis sequelae, cases of non-bacteremic pneumonia, and direct non-medical costs were not included. CONCLUSIONS IPD and AOM cases and costs were estimated in a hypothetical US birth cohort followed for 20 years at three time periods. In all three periods, the serotypes targeted by V114 contributed to significant morbidity and costs. New pediatric pneumococcal vaccines must continue to retain serotypes in licensed vaccines to maintain disease reduction while extending coverage to non-vaccine serotypes.
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Affiliation(s)
- Tianyan Hu
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Thomas Weiss
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Kwame Owusu-Edusei
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
| | - Tanaz Petigara
- Center for Observational and Real-world Evidence, Merck & Co., Inc., Kenilworth, NJ, USA
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Mohanty S, Sukarom I, Mears G, Owusu-Edusei K, Hu T. PRS3 Health and Economic Burden Associated with 15-Valent Pneumococcal Conjugate Vaccine (V114) Serotypes in Children in Australia. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Mohanty S, Sukarom I, Owusu-Edusei K, Hu T. PIN18 Health and Economic Burden Associated with 15-Valent Pneumococcal Conjugate Vaccine (V114) Serotypes in Children in New Zealand. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Aslam MV, Owusu-Edusei K, Nesheim SR, Gray KM, Lampe MA, Dietz PM. Trends in Women With an HIV Diagnosis at Delivery Hospitalization in the United States, 2006-2014. Public Health Rep 2020; 135:524-533. [PMID: 32649273 DOI: 10.1177/0033354920935074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The risk of mother-to-child HIV transmission can be reduced to ≤0.5% if the mother's HIV status is known before delivery. This study describes 2006-2014 trends in diagnosed HIV infection documented on delivery discharge records and associated sociodemographic characteristics among women who gave birth in US hospitals. METHODS We analyzed data from the 2006-2014 National Inpatient Sample and identified delivery discharges and women with diagnosed HIV infection by using International Classification of Diseases, Ninth Revision, Clinical Modification codes. We used a generalized linear model with log link and binomial distribution to assess trends and the association of sociodemographic characteristics with an HIV diagnosis on delivery discharge records. RESULTS During 2006-2014, an HIV diagnosis was documented on approximately 3900-4400 delivery discharge records annually. The probability of having an HIV diagnosis on delivery discharge records decreased 3% per year (adjusted relative risk [aRR] = 0.97; 95% CI, 0.94-0.99), with significant declines identified among white women aged 25-34 (aRR = 0.93; 95% CI, 0.88-0.97) or those using Medicaid (aRR = 0.93; 95% CI, 0.90-0.97); among black women aged 25-34 (aRR = 0.95; 95% CI, 0.92-0.99); and among privately insured women who were black (aRR = 0.96; 95% CI, 0.92-0.99), Hispanic (aRR = 0.92; 95% CI, 0.86-0.98), or aged 25-34 (aRR = 0.96; 95% CI, 0.92-0.99). The probability of having an HIV diagnosis on delivery discharge records was greater for women who were black (aRR = 8.45; 95% CI, 7.56-9.44) or Hispanic (aRR = 1.56; 95% CI, 1.33-1.83) than white; for women aged 25-34 (aRR = 2.33; 95% CI, 2.12-2.55) or aged ≥35 (aRR = 3.04; 95% CI, 2.79-3.31) than for women aged 13-24; and for Medicaid recipients (aRR = 2.70; 95% CI, 2.45-2.98) or the uninsured (aRR = 1.87; 95% CI, 1.60-2.19) than for privately insured patients. CONCLUSION During 2006-2014, the probability of having an HIV diagnosis declined among select sociodemographic groups of women delivering neonates. High-impact prevention efforts tailored to women remaining at higher risk for HIV infection can reduce the risk of mother-to-child HIV transmission.
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Affiliation(s)
- Maria Vyshnya Aslam
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kwame Owusu-Edusei
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Steven R Nesheim
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristen Mahle Gray
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Margaret A Lampe
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Patricia Marie Dietz
- 1242 National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Owusu-Edusei K, Chang BA. Investigating Multiple-Reported Bacterial Sexually Transmitted Infection Hot Spot Counties in the United States: Ordered Spatial Logistic Regression. Sex Transm Dis 2020; 46:771-776. [PMID: 31688724 DOI: 10.1097/olq.0000000000001078] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To identify and examine the correlates of multiple bacterial sexually transmitted infection (STI) hot spot counties in the United States. METHODS We assembled and analyzed 5 years (2008-2012) of cross-sectional STI morbidity data to identify multiple bacterial STI (chlamydia, gonorrhea, and syphilis) hot spot counties using hot spot analysis. Then, we examined the association between the multi-STI hot spots and select multiyear (2008-2012) sociodemographic factors (data obtained from the American Community Survey) using ordered spatial logistic regression analyses. RESULTS Of the 2935 counties, the results indicated that 85 counties were hot spots for all 3 STIs (3-STI hot spot counties), 177 were hot spots for 2 STIs (2-STI hot spot counties), and 145 were hot spots for only 1 STI (1-STI hot spot counties). Approximately 93% (79 of 85) of the counties determined to be 3-STI hot spots were found in 4 southern states--Mississippi (n = 25), Arkansas (n = 22), Louisiana (n = 19), and Alabama (n = 13). Counties determined to be 2 STI hot spots were found in 7 southern states--Arkansas, Louisiana, Mississippi, Alabama, Georgia, and North and South Carolina had at least ten 2-STI hot spot counties each. The multi-STI hot spot classes were significantly (P < 0.05) associated with percent black (non-Hispanic), percent Hispanics, percent American Indians, population density, male-female sex ratio, percent aged 25 to 44 years, and violent crime rate. CONCLUSIONS This study provides information on multiple STI hot spot counties in the United States and the associated sociodemographic factors. Such information can be used to assist planning, designing, and implementing effective integrated bacterial STI prevention and control programs/interventions.
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Affiliation(s)
- Kwame Owusu-Edusei
- From the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Brian A Chang
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY
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Owusu-Edusei K, Chang BA, Aslam MV, Johnson RA, Pearson WS, Chesson HW. Does including violent crime rates in ecological regression models of sexually transmissible infection rates improve model quality? Insights from spatial regression analyses. Sex Health 2020; 16:148-157. [PMID: 30885293 DOI: 10.1071/sh17221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 11/22/2018] [Indexed: 11/23/2022]
Abstract
Background Violent crime rates are often correlated with the hard-to-measure social determinants of sexually transmissible infections (STIs). In this study, we examined whether including violent crime rate as an independent variable can improve the quality of ecological regression models of STIs. METHODS We obtained multiyear (2008-12) cross-sectional county-level data on violent crime and three STIs (chlamydia, gonorrhoea, and primary and secondary (P&S) syphilis) from counties in all the contiguous states in the US (except Illinois and Florida, due to lack of data). We used two measures of STI morbidity (one categorical and one continuous) and applied spatial regression with the spatial error model for each STI, with and without violent crime rate as an independent variable. We computed the associated Akaike's information criterion (AIC) and Bayesian information criterion (BIC) as our measure of the relative goodness of fit of the models. RESULTS Including the violent crime rate as an independent variable improved the quality of the regression models after controlling for several sociodemographic factors. We found that the lower calculated AICs and BICs indicated more favourable goodness of fit in all the models that included violent crime rates, except for the categorical P&S syphilis model, in which the violent crime variable was not statistically significant. CONCLUSION Because violent crime rates can account for the hard-to-measure social determinants of STIs, including violent crime rate as an independent variable can improve ecological regression models of STIs.
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Affiliation(s)
- Kwame Owusu-Edusei
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road MS E-07, Atlanta, GA 30329, USA; and Corresponding author.
| | - Brian A Chang
- Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Maria V Aslam
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road MS E-07, Atlanta, GA 30329, USA
| | - Ryan A Johnson
- Department of Health and Kinesiology at Texas A&M University, 332 Blocker, College Station, TX 77843, USA
| | - William S Pearson
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road MS E-07, Atlanta, GA 30329, USA
| | - Harrell W Chesson
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road MS E-07, Atlanta, GA 30329, USA
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18
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Abstract
During the 2015-2016 school year, the Florida Department of Health in Duval County hosted Teen Health Centers (TeenHC) at five high schools of Jacksonville providing HIV/STD screening and pregnancy testing. The purpose of this study was to assess the cost-effectiveness of the TeenHC chlamydia screening program and determine at what student participation level, the program can be cost-effective. We assessed the costs and effectiveness of the chlamydia screening program compared with "no TeenHC". Cost-effectiveness was measured as cost per quality-adjusted life years (QALY) gained. At a program cost of US$61,001 and 3% participation rate, the cost/QALY gained was $124,328 in the base-case analysis and $81,014-$264,271 in 95% of the simulation trials, all greater than the frequently citied $50,000/QALY benchmark. The cost/QALY gained could be <$50,000/QALY if student participation rate was >7%. The TeenHC chlamydia screening has the potential to be cost-effective. Future program efforts should focus on improving student participation.
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Affiliation(s)
- Li Yan Wang
- Division of Adolescent and School Health, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kwame Owusu-Edusei
- Program and Performance Improvement Office, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - J Terry Parker
- Division of Adolescent and School Health, 1242Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kristina Wilson
- Florida Department of Health in Duval County, Jacksonville, FL, USA
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19
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Tao G, Owusu-Edusei K, Friedman E, Aslam M, Viall AH, Dietz P, Gift TL. Significant difference in HEDIS annual chlamydia testing rates between women who had given birth and those who had not among young Medicaid women. Sex Health 2019; 15:374-375. [PMID: 29860971 DOI: 10.1071/sh18003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 02/14/2018] [Indexed: 11/23/2022]
Abstract
We used the 2013 Medicaid Analytic eXtract (MAX) database to estimate chlamydia testing rates separately for sexually active women aged 15-25 years who had, or had not, given birth in 2013. Approximately 9.2% of sexually active women aged 15-25 years gave birth in 2013. The Healthcare Effectiveness Data Information Set (HEDIS) annual chlamydia testing rate was significantly higher among women who had given birth than women who had not in 2013 (59.7 vs 29.4%, P<0.05). Our findings suggest a need for more research to understand how differences in population mix changes and preventive screening practices for pregnant and non-pregnant women affect publicly reported chlamydia screening rates.
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Affiliation(s)
- Guoyu Tao
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Kwame Owusu-Edusei
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Eleanor Friedman
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Maria Aslam
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Abigail H Viall
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Patricia Dietz
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Thomas L Gift
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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20
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Aslam MV, Owusu-Edusei K, Marks SM, Asay GRB, Miramontes R, Kolasa M, Winston CA, Dietz PM. Number and cost of hospitalizations with principal and secondary diagnoses of tuberculosis, United States. Int J Tuberc Lung Dis 2019; 22:1495-1504. [PMID: 30606323 DOI: 10.5588/ijtld.18.0260] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To estimate the number and cost of hospitalizations with a diagnosis of active tuberculosis (TB) disease in the United States. METHODS We analyzed the 2014 National In-Patient Sample using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes to identify hospitalizations with a principal (TB-PD) or any secondary discharge (TB-SD) TB diagnosis. We used a generalized linear model with log link and gamma distribution to estimate the cost per TB-PD and TB-SD episode adjusted for patient demographics, insurer, clinical elements, and hospital characteristics. RESULTS We estimated 4985 TB-PD and 6080 TB-SD hospitalizations nationwide. TB-PD adjusted averaged $16 695 per episode (95%CI $16 168-$17 221). The average for miliary/disseminated TB ($22 498, 95%CI $21 067-$23 929) or TB of the central nervous system ($28 338, 95%CI $25 836-$30 840) was significantly greater than for pulmonary TB ($14 819, 95%CI $14 284-$15 354). The most common principal diagnoses for TB-SD were septicemia (n = 965 hospitalizations), human immunodeficiency virus infection (n = 610), pneumonia (n = 565), and chronic obstructive pulmonary disease and bronchiectasis (COPD-B, n = 150). The adjusted average cost per TB-SD episode was $15 909 (95%CI $15 337-$16 481), varying between $8687 (95%CI $8337-$9036) for COPD-B and $23 335 (95%CI $21 979-$24 690) for septicemia. TB-PD cost the US health care system $123.4 million (95%CI $106.3-$140.5) and TB-SD cost $141.9 million ($128.4-$155.5), of which Medicaid/Medicare covered respectively 67.2% and 69.7%. CONCLUSIONS TB hospitalizations result in substantial costs within the US health care system.
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Affiliation(s)
- M V Aslam
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - K Owusu-Edusei
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - S M Marks
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - G R B Asay
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - R Miramontes
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - M Kolasa
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - C A Winston
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - P M Dietz
- National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Marks SM, Woodruff RY, Owusu-Edusei K, Asay GRB, Hill AN. Estimates of Testing for Latent Tuberculosis Infection and Cost, United States, 2013. Public Health Rep 2019; 134:522-527. [PMID: 31339816 DOI: 10.1177/0033354919862688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Tracking trends in the testing of latent tuberculosis infection (LTBI) can help measure tuberculosis elimination efforts in the United States. The objectives of this study were to estimate (1) the annual number of persons tested for LTBI and the number of LTBI tests conducted, by type of test and by public, private, and military sectors, and (2) the cost of LTBI testing in the United States. METHODS We searched the biomedical literature for published data on private-sector and military LTBI testing in 2013, and we used back-calculation to estimate public-sector LTBI testing. To estimate costs, we applied Medicare-allowable reimbursements in 2013 by test type. RESULTS We estimated an average (low-high) 13.3 million (11.3-15.4 million) persons tested for LTBI and 15.3 million (12.9-17.7 million) LTBI tests, of which 13.2 million (11.1-15.3 million) were tuberculin skin tests and 2.1 million (1.8-2.4 million) were interferon-γ release assays (IGRAs). Eighty percent of persons tested were in the public sector, 18% were in the private sector, and 2% were in the military. Costs of LTBI tests and of chest radiography totaled $314 million (range, $256 million to $403 million). CONCLUSIONS To achieve tuberculosis elimination, millions more persons will need to be tested in all sectors. By targeting testing to only those at high risk of tuberculosis and by using more specific IGRA tests, the incidence of tuberculosis in the United States can be reduced and resources can be more efficiently used.
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Affiliation(s)
- Suzanne M Marks
- 1 Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rachel Yelk Woodruff
- 1 Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kwame Owusu-Edusei
- 2 National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Garrett R Beeler Asay
- 1 Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Andrew N Hill
- 1 Division of Tuberculosis Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Tao G, Owusu-Edusei K, Friedman E, Aslam M, Viall AH, Dietz P, Gift TL. Corrigendum to: Significant difference in HEDIS annual chlamydia testing rates between women who had given birth and those who had not among young Medicaid women. Sex Health 2019; 15:379. [PMID: 31040003 DOI: 10.1071/sh18003_co] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We used the 2013 Medicaid Analytic eXtract (MAX) database to estimate chlamydia testing rates separately for sexually active women aged 15-25 years who had, or had not, given birth in 2013. Approximately 9.2% of sexually active women aged 15-25 years gave birth in 2013. The Healthcare Effectiveness Data Information Set (HEDIS) annual chlamydia testing rate was significantly higher among women who had given birth than women who had not in 2013 (59.7 vs 29.4%, P<0.05). Our findings suggest a need for more research to understand how differences in population mix changes and preventive screening practices for pregnant and non-pregnant women affect publicly reported chlamydia screening rates.
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23
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Teshale EH, Asher A, Aslam MV, Augustine R, Duncan E, Rose-Wood A, Ward J, Mermin J, Owusu-Edusei K, Dietz PM. Estimated cost of comprehensive syringe service program in the United States. PLoS One 2019; 14:e0216205. [PMID: 31026295 PMCID: PMC6485753 DOI: 10.1371/journal.pone.0216205] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/16/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To estimate the cost of establishing and operating a comprehensive syringe service program (SSP) free to clients in the United States. METHODS We identified the major cost components of a comprehensive SSP: (one-time start-up cost, and annual costs associated with personnel, operations, and prevention/medical services) and estimated the anticipated total costs (2016 US dollars) based on program size (number of clients served each year) and geographic location of the service (rural, suburban, and urban). RESULTS The estimated costs ranged from $0.4 million for a small rural SSP (serving 250 clients) to $1.9 million for a large urban SSP (serving 2,500 clients), of which 1.6% and 0.8% is the start-up cost of a small rural and large urban SSP, respectively. Cost per syringe distributed varied from $3 (small urban SSP) to $1 (large rural SSP), and cost per client per year varied from $2000 (small urban SSP) to $700 (large rural SSP). CONCLUSIONS Estimates of the cost of SSPs in the United States vary by number of clients served and geographic location of service. Accurate costing can be useful for planning programs, developing policy, allocating funds for establishing and supporting SSPs, and providing data for economic evaluation of SSPs.
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Affiliation(s)
- Eyasu H. Teshale
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, GA, United States of America
- * E-mail:
| | - Alice Asher
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, GA, United States of America
| | - Maria V. Aslam
- Office of the Director, National Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, GA, United States of America
| | - Ryan Augustine
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, GA, United States of America
| | - Eliana Duncan
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, GA, United States of America
| | - Alyson Rose-Wood
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, GA, United States of America
| | - John Ward
- Division of Viral Hepatitis, National Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, GA, United States of America
| | - Jonathan Mermin
- Office of the Director, National Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, GA, United States of America
| | - Kwame Owusu-Edusei
- Office of the Director, National Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, GA, United States of America
| | - Patricia M. Dietz
- Office of the Director, National Center for HIV, Viral Hepatitis, STD and TB Prevention, CDC, Atlanta, GA, United States of America
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Abstract
BACKGROUND National trends in syphilis rates among females delivering newborns are not well characterized. We assessed 2010-2014 trends in syphilis diagnoses documented on discharge records and associated factors among females who have given birth in US hospitals. METHODS We calculated quarterly trends in syphilis rates (per 100,000 deliveries) by using International Classification of Diseases, Ninth Revision, Clinical Modification codes on delivery discharge records from the National Inpatient Sample. Changes in trends were determined by using Joinpoint software. We estimated relative risks (RR) to assess the association of syphilis diagnoses with race/ethnicity, age, insurance status, household income, and census region. RESULTS Overall, estimated syphilis rates decreased during 2010-2012 at 1.0% per quarter (P < 0.001) and increased afterward at 1.8% (P < 0.001). The syphilis rate increase was statistically significant across all sociodemographic groups and all US regions, with substantial increases identified among whites (35.2% per quarter; P < 0.001) and Medicaid recipients (15.1%; P < 0.001). In 2014, the risk of syphilis diagnosis was greater among blacks (RR, 13.02; 95% confidence interval [CI], 9.46-17.92) or Hispanics (RR, 4.53; 95% CI, 3.19-6.42), compared with whites; Medicaid recipients (RR, 4.63; 95% CI, 3.38-6.33) or uninsured persons (RR, 2.84; 95% CI, 1.74-4.63), compared with privately insured patients; females with the lowest household income (RR, 5.32; 95% CI, 3.55-7.97), compared with the highest income; and females in the South (RR, 2.42; 95% CI, 1.66-3.53), compared with the West. CONCLUSIONS Increasing syphilis rates among pregnant females of all backgrounds reinforce the importance of prenatal screening and treatment.
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Affiliation(s)
- Maria V Aslam
- From the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Owusu-Edusei K, Patel CG, Gift TL. Does place of service matter? A utilisation and cost analysis of sexually transmissible infection testing from 2012 claims data. Sex Health 2018; 13:131-9. [PMID: 26774890 DOI: 10.1071/sh15066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 11/02/2015] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background In this study, a previous study on the utilisation and cost of sexually transmissible infection (STI) tests was augmented by focusing on outpatient place of service for the most utilised tests. METHODS Claims for eight STI tests [chlamydia, gonorrhoea, hepatitis B virus (HBV), HIV, human papillomavirus (HPV), herpes simplex virus type 2 (HSV2), syphilis and trichomoniasis] using the most utilised current procedural terminology (CPT) code for each STI from the 2012 MarketScan outpatient table were extracted. The volume and costs by gender and place of service were then summarised. Finally, semi-log regression analyses were used to further examine and compare costs. RESULTS Females had a higher number of test claims than males in all places of service for each STI. Together, claims from 'Independent Laboratories', 'Office' and 'Outpatient hospital' accounted for over 93% of all the test claims. The cost of tests were slightly (<5%) different between males and females for most places of service. Except for the estimated average cost for 'Outpatient hospital', the estimated average costs for the other categories were significantly lower (15-80%, P<0.01) than the estimated average cost for 'Emergency Room - Hospital' for all the STIs. Among the predominant service venues, test costs from 'Independent Laboratory' and 'Office' were 30% to 69% lower (P<0.01) than those from 'Outpatient Hospital'. CONCLUSIONS Even though the results from this study are not generalisable, our study shows that almost all STI tests from outpatient claims data were performed in three service venues with considerable cost variations.
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Affiliation(s)
- Kwame Owusu-Edusei
- Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road MS E-80, Atlanta, GA30333, USA
| | - Chirag G Patel
- Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road MS E-80, Atlanta, GA30333, USA
| | - Thomas L Gift
- Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road MS E-80, Atlanta, GA30333, USA
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Owusu-Edusei K, Marks SM, Miramontes R, Stockbridge EL, Winston CA. Tuberculosis hospitalization expenditures per patient from private health insurance claims data, 2010-2014. Int J Tuberc Lung Dis 2018; 21:398-404. [PMID: 28284254 DOI: 10.5588/ijtld.16.0587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine hospitalization expenditures for tuberculosis (TB) disease among privately insured patients in the United States. METHODS We extracted TB hospital admissions data from the 2010-2014 MarketScan® commercial database using International Classification of Diseases version 9 codes for TB (011.0-018.96) as the principal diagnosis. We estimated adjusted average expenditures (in 2014 USD) using regression analyses controlling for patient and claim characteristics. We also estimated the total expenditure paid by enrollee and insurance, and extrapolated it to the entire US employer-based privately insured population. RESULTS We found 892 TB hospitalizations representing 825 unique enrollees over the 5-year period. The average hospitalization expenditure per person (including multiple hospitalizations) was US$33 085 (95%CI US$31 606- US$34 565). Expenditures for central nervous system TB (US$73 065, 95%CI US$59 572-US$86 558), bone and joint TB (US$56 842, 95%CI US$39 301-US$74 383), and miliary/disseminated TB (US$55 487, 95%CI US$46 101-US$64 873) were significantly higher than those for pulmonary TB (US$28 058, 95%CI US$26 632-US$29 484). The overall total expenditure for hospitalizations for TB disease over the period (2010-2014) was US$38.4 million; it was US$154 million when extrapolated to the entire employer-based privately insured population in the United States. CONCLUSIONS Hospitalization expenditures for some forms of extra-pulmonary TB were substantially higher than for pulmonary TB.
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Affiliation(s)
- K Owusu-Edusei
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - S M Marks
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - R Miramontes
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - E L Stockbridge
- Department of Health Management and Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, Department of Health Behavior and Health Systems, Magellan Health Inc, Scottsdale, Arizona, USA
| | - C A Winston
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
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Owusu-Edusei K, Stockbridge EL, Winston CA, Kolasa M, Miramontes R. Tuberculin skin test and interferon-gamma release assay use among privately insured persons in the United States. Int J Tuberc Lung Dis 2017; 21:684-689. [PMID: 28351463 DOI: 10.5588/ijtld.16.0617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe tuberculin skin test (TST) and interferon-gamma release assay (IGRA) (i.e., QuantiFERON®-TB [QFT] and T-SPOT®.TB [T-SPOT]) use among privately insured persons in the United States over a 15-year period. METHODS We used current procedural terminology (CPT) codes for the TST and IGRAs to extract out-patient claims (2000-2014) and determined usage (claims/100 000). The χ2 test for trend in proportions was used to describe usage trends for select periods. RESULTS The TST was the dominant (>80%) test in each year. Publication of guidelines preceded the assignment of QFT and T-SPOT CPT codes by 1 year (2006 for QFT; 2011 for T-SPOT). QFT usage was higher (P < 0.01) than T-SPOT in each year. The average annual increase in the use of QFT was higher than that of T-SPOT (35 vs. 3.8/100 000), and more so when the analytic period was 2011-2014 (65 vs. 38/100 000). However, during that 4-year period (2011-2014), TST use trended downward, with an average annual decrease of 28/100 000. The annual proportion of enrollees tested ranged from 1.1% to 1.5%. CONCLUSIONS These results suggest a gradual shift from the use of the TST to the newer IGRAs. Future studies can assess the extent, if any, to which the shift from the use of the TST to IGRAs evolved over time.
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Affiliation(s)
- K Owusu-Edusei
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - E L Stockbridge
- Department of Health Behavior and Health Systems, School of Public Health, University of North Texas Health Science Center, Fort Worth, Texas, Department of Advanced Health Analytics and Solutions, Magellan Health, Inc., Scottsdale, Arizona, USA
| | - C A Winston
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Kolasa
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - R Miramontes
- Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Georgia
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Owusu-Edusei K, Cramer R, Chesson HW, Gift TL, Leichliter JS. State-level gonorrhea rates and expedited partner therapy laws: insights from time series analyses. Public Health 2017; 147:101-108. [PMID: 28404485 DOI: 10.1016/j.puhe.2017.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 12/09/2016] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In this study, we examined state-level monthly gonorrhea morbidity and assessed the potential impact of existing expedited partner therapy (EPT) laws in relation to the time that the laws were enacted. STUDY DESIGN Longitudinal study. METHODS We obtained state-level monthly gonorrhea morbidity (number of cases/100,000 for males, females and total) from the national surveillance data. We used visual examination (of morbidity trends) and an autoregressive time series model in a panel format with intervention (interrupted time series) analysis to assess the impact of state EPT laws based on the months in which the laws were enacted. RESULTS For over 84% of the states with EPT laws, the monthly morbidity trends did not show any noticeable decreases on or after the laws were enacted. Although we found statistically significant decreases in gonorrhea morbidity within four of the states with EPT laws (Alaska, Illinois, Minnesota, and Vermont), there were no significant decreases when the decreases in the four states were compared contemporaneously with the decreases in states that do not have the laws. CONCLUSION We found no impact (decrease in gonorrhea morbidity) attributable exclusively to the EPT law(s). However, these results do not imply that the EPT laws themselves were not effective (or failed to reduce gonorrhea morbidity), because the effectiveness of the EPT law is dependent on necessary intermediate events/outcomes, including sexually transmitted infection service providers' awareness and practice, as well as acceptance by patients and their partners.
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Affiliation(s)
- K Owusu-Edusei
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA.
| | - R Cramer
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - H W Chesson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - T L Gift
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - J S Leichliter
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Chang BA, Pearson WS, Owusu-Edusei K. Correlates of county-level nonviral sexually transmitted infection hot spots in the US: application of hot spot analysis and spatial logistic regression. Ann Epidemiol 2017; 27:231-237. [PMID: 28302356 DOI: 10.1016/j.annepidem.2017.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 12/28/2016] [Accepted: 02/07/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE We used a combination of hot spot analysis (HSA) and spatial regression to examine county-level hot spot correlates for the most commonly reported nonviral sexually transmitted infections (STIs) in the 48 contiguous states in the United States (US). METHODS We obtained reported county-level total case rates of chlamydia, gonorrhea, and primary and secondary (P&S) syphilis in all counties in the 48 contiguous states from national surveillance data and computed temporally smoothed rates using 2008-2012 data. Covariates were obtained from county-level multiyear (2008-2012) American Community Surveys from the US census. We conducted HSA to identify hot spot counties for all three STIs. We then applied spatial logistic regression with the spatial error model to determine the association between the identified hot spots and the covariates. RESULTS HSA indicated that ≥84% of hot spots for each STI were in the South. Spatial regression results indicated that, a 10-unit increase in the percentage of Black non-Hispanics was associated with ≈42% (P < 0.01) [≈22% (P < 0.01), for Hispanics] increase in the odds of being a hot spot county for chlamydia and gonorrhea, and ≈27% (P < 0.01) [≈11% (P < 0.01) for Hispanics] for P&S syphilis. Compared with the other regions (West, Midwest, and Northeast), counties in the South were 6.5 (P < 0.01; chlamydia), 9.6 (P < 0.01; gonorrhea), and 4.7 (P < 0.01; P&S syphilis) times more likely to be hot spots. CONCLUSION Our study provides important information on hot spot clusters of nonviral STIs in the entire United States, including associations between hot spot counties and sociodemographic factors.
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Affiliation(s)
- Brian A Chang
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; Icahn School of Medicine at Mount Sinai, New York, NY
| | - William S Pearson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kwame Owusu-Edusei
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
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Owusu-Edusei K, Hoover KW, Gift TL. Cost-Effectiveness of Opt-Out Chlamydia Testing for High-Risk Young Women in the U.S. Am J Prev Med 2016; 51:216-224. [PMID: 26952078 PMCID: PMC6785744 DOI: 10.1016/j.amepre.2016.01.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/09/2015] [Accepted: 01/19/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In spite of chlamydia screening recommendations, U.S. testing coverage continues to be low. This study explored the cost-effectiveness of a patient-directed, universal, opportunistic Opt-Out Testing strategy (based on insurance coverage, healthcare utilization, and test acceptance probabilities) for all women aged 15-24 years compared with current Risk-Based Screening (30% coverage) from a societal perspective. METHODS Based on insurance coverage (80%); healthcare utilization (83%); and test acceptance (75%), the proposed Opt-Out Testing strategy would have an expected annual testing coverage of approximately 50% for sexually active women aged 15-24 years. A basic compartmental heterosexual transmission model was developed to account for population-level transmission dynamics. Two groups were assumed based on self-reported sexual activity. All model parameters were obtained from the literature. Costs and benefits were tracked over a 50-year period. The relative sensitivity of the estimated incremental cost-effectiveness ratios to the variables/parameters was determined. This study was conducted in 2014-2015. RESULTS Based on the model, the Opt-Out Testing strategy decreased the overall chlamydia prevalence by >55% (2.7% to 1.2%). The Opt-Out Testing strategy was cost saving compared with the current Risk-Based Screening strategy. The estimated incremental cost-effectiveness ratio was most sensitive to the female pre-opt out prevalence, followed by the probability of female sequelae and discount rate. CONCLUSIONS The proposed Opt-Out Testing strategy was cost saving, improving health outcomes at a lower net cost than current testing. However, testing gaps would remain because many women might not have health insurance coverage, or not utilize health care.
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Fan L, Owusu-Edusei K, Schillie SF, Murphy TV. Cost-effectiveness of active-passive prophylaxis and antiviral prophylaxis during pregnancy to prevent perinatal hepatitis B virus infection. Hepatology 2016; 63:1471-80. [PMID: 26509655 DOI: 10.1002/hep.28310] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 10/26/2015] [Indexed: 12/12/2022]
Abstract
UNLABELLED In an era of antiviral treatment, reexamination of the cost-effectiveness of strategies to prevent perinatal hepatitis B virus (HBV) transmission in the United States is needed. We used a decision tree and Markov model to estimate the cost-effectiveness of the current U.S. strategy and two alternatives: (1) Universal hepatitis B vaccination (HepB) strategy: No pregnant women are screened for hepatitis B surface antigen (HBsAg). All infants receive HepB before hospital discharge; no infants receive hepatitis B immunoglobulin (HBIG). (2) Current strategy: All pregnant women are screened for HBsAg. Infants of HBsAg-positive women receive HepB and HBIG ≤12 hours of birth. All other infants receive HepB before hospital discharge. (3) Antiviral prophylaxis strategy: All pregnant women are screened for HBsAg. HBsAg-positive women have HBV-DNA load measured. Antiviral prophylaxis is offered for 4 months starting in the third trimester to women with DNA load ≥10(6) copies/mL. HepB and HBIG are administered at birth to infants of HBsAg-positive women, and HepB is administered before hospital discharge to infants of HBsAg-negative women. Effects were measured in quality-adjusted life years (QALYs) and incremental cost-effectiveness ratios (ICER). Compared to the universal HepB strategy, the current strategy prevented 1,006 chronic HBV infections and saved 13,600 QALYs (ICER: $6,957/QALY saved). Antiviral prophylaxis dominated the current strategy, preventing an additional 489 chronic infections, and saving 800 QALYs and $2.8 million. The results remained robust over a wide range of assumptions. CONCLUSION The current U.S. strategy for preventing perinatal HBV remains cost-effective compared to the universal HepB strategy. An antiviral prophylaxis strategy was cost saving compared to the current strategy and should be considered to continue to decrease the burden of perinatal hepatitis B in the United States.
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Affiliation(s)
- Lin Fan
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kwame Owusu-Edusei
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah F Schillie
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Trudy V Murphy
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Chang B, Pearson W, Owusu-Edusei K. Correlates of county-level non-viral sexually transmitted infection hot spots in the US. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.02.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Abstract
A successful vaccine could be a cost-effective addition to current screening practices. We explored potential cost-effectiveness of a chlamydia vaccine for young women in the United States by using a compartmental heterosexual transmission model. We tracked health outcomes (acute infections and sequelae measured in quality-adjusted life-years [QALYs]) and determined incremental cost-effectiveness ratios (ICERs) over a 50-year analytic horizon. We assessed vaccination of 14-year-old girls and catch-up vaccination for 15–24-year-old women in the context of an existing chlamydia screening program and assumed 2 prevaccination prevalences of 3.2% by main analysis and 3.7% by additional analysis. Estimated ICERs of vaccinating 14-year-old girls were $35,300/QALY by main analysis and $16,200/QALY by additional analysis compared with only screening. Catch-up vaccination for 15–24-year-old women resulted in estimated ICERs of $53,200/QALY by main analysis and $26,300/QALY by additional analysis. The ICER was most sensitive to prevaccination prevalence for women, followed by cost of vaccination, duration of vaccine-conferred immunity, and vaccine efficacy. Our results suggest that a successful chlamydia vaccine could be cost-effective.
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Owusu-Edusei K, Carroll DS, Gift TL. Examining Fluoroquinolone Claims Among Gonorrhea-Associated Prescription Drug Claims, 2000-2010. Am J Prev Med 2015; 49:761-764. [PMID: 26190198 PMCID: PMC6805127 DOI: 10.1016/j.amepre.2015.04.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 04/08/2015] [Accepted: 04/27/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION After the release of CDC's revised gonorrhea treatment guidelines in April 2007, a study reported the declining use of fluoroquinolones to treat gonorrhea among health departments participating in the Sexually Transmitted Disease Surveillance Network. In this study, we examine the proportion of fluoroquinolone claims among gonorrhea-associated prescription drug claims from a large insurance database from 2000 through 2010. METHODS We extracted drug claims associated with gonorrhea diagnosis claims from the MarketScan database for 2000-2010 and calculated the proportion of the drug claims for fluoroquinolones on a monthly basis. We then used an interrupted time series analysis to investigate trend characteristics of fluoroquinolone claims before and after the gonorrhea treatment guidelines were revised in April 2007. RESULTS Although there was a monthly decline in the proportion of fluoroquinolone claims before April 2007 (-0.11 percentage points, p<0.01), results indicate a sevenfold (-0.78 percentage points, p<0.01) increase in the rate of decline after the revised guidelines were released in April 2007. We did not find any sudden drop (immediate or delayed) in the proportion of fluoroquinolones after April 2007, implying a gradual permanent decline over the analytic period. CONCLUSIONS Our results are consistent with the findings of the previous study and indicate a gradual and permanent decline (over the analytic period) in the proportion of fluoroquinolone claims among gonorrhea-associated prescription drug claims. However, because this is a convenience sample of claims data, these findings cannot be generalized to the entire privately insured population in the U.S.
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Tao G, Neblett Fanfair R, Owusu-Edusei K, Gift T, Bernstein KT. P09.18 Suboptimal prenatal testing for syphilis and other stds among commercially-insured women in the united states, 2013. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Owusu-Edusei K, Flagg EW, Gift TL. Hospitalization cost per case of neonatal herpes simplex virus infection from claims data. J Pediatr Nurs 2015; 30:346-52. [PMID: 25193688 DOI: 10.1016/j.pedn.2014.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to estimate the average excess inpatient cost of neonatal herpes simplex virus (NHSV) infection from 2005 to 2009 insurance claims data. The estimated adjusted average excess inpatient cost for neonate admissions with HSV diagnosis and >7 days of hospitalization was $40,044 [95% confidence interval (CI), $33,529-$47,775]. When disaggregated by the days of admission, cost estimates were: 8-13 days, $23,918 [CI, $19,490-$29,282]; 14-21 days, $44,358 [CI, $34,654-$56,673]; >21 days, $68,916 [CI, $49,905-$94,967]). Although these estimates are not representative of the entire US, they can inform future economic evaluation studies on NHSV interventions.
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Affiliation(s)
- Kwame Owusu-Edusei
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Elaine W Flagg
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Thomas L Gift
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Chesson HW, Kirkcaldy RD, Gift TL, Owusu-Edusei K, Weinstock HS. Ciprofloxacin resistance and gonorrhea incidence rates in 17 cities, United States, 1991-2006. Emerg Infect Dis 2014; 20:612-9. [PMID: 24655615 PMCID: PMC3966369 DOI: 10.3201/eid2004.131288] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Antimicrobial drug resistance can hinder gonorrhea prevention and control efforts. In this study, we analyzed historical ciprofloxacin resistance data and gonorrhea incidence data to examine the possible effect of antimicrobial drug resistance on gonorrhea incidence at the population level. We analyzed data from the Gonococcal Isolate Surveillance Project and city-level gonorrhea incidence rates from surveillance data for 17 cities during 1991–2006. We found a strong positive association between ciprofloxacin resistance and gonorrhea incidence rates at the city level during this period. Their association was consistent with predictions of mathematical models in which resistance to treatment can increase gonorrhea incidence rates through factors such as increased duration of infection. These findings highlight the possibility of future increases in gonorrhea incidence caused by emerging cephalosporin resistance.
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Fan L, Owusu-Edusei K, Schillie SF, Murphy TV. Cost-effectiveness of testing hepatitis B-positive pregnant women for hepatitis B e antigen or viral load. Obstet Gynecol 2014; 123:929-937. [PMID: 24785842 PMCID: PMC4682356 DOI: 10.1097/aog.0000000000000124] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To estimate the cost-effectiveness of testing pregnant women with hepatitis B (hepatitis B surface antigen [HBsAg]-positive) for hepatitis B e antigen (HBeAg) or hepatitis B virus (HBV) DNA, and administering maternal antiviral prophylaxis if indicated, to decrease breakthrough perinatal HBV transmission from the U.S. health care perspective. METHODS A Markov decision model was constructed for a 2010 birth cohort of 4 million neonates to estimate the cost-effectiveness of two strategies: testing HBsAg-positive pregnant women for 1) HBeAg or 2) HBV load. Maternal antiviral prophylaxis is given from 28 weeks of gestation through 4 weeks postpartum when HBeAg is positive or HBV load is high (10 copies/mL or greater). These strategies were compared with the current recommendation. All neonates born to HBsAg-positive women received recommended active-passive immunoprophylaxis. Effects were measured in quality-adjusted life-years (QALYs) and all costs were in 2010 U.S. dollars. RESULTS The HBeAg testing strategy saved $3.3 million and 3,080 QALYs and prevented 486 chronic HBV infections compared with the current recommendation. The HBV load testing strategy cost $3 million more than current recommendation, saved 2,080 QALYs, and prevented 324 chronic infections with an incremental cost-effectiveness ratio of $1,583 per QALY saved compared with the current recommendations. The results remained robust over a wide range of assumptions. CONCLUSION Testing HBsAg-positive pregnant women for HBeAg or HBV load followed by maternal antiviral prophylaxis if HBeAg-positive or high viral load to reduce perinatal hepatitis B transmission in the United States is cost-effective.
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MESH Headings
- Antibiotic Prophylaxis/economics
- Antiviral Agents/economics
- Antiviral Agents/therapeutic use
- Cost-Benefit Analysis
- DNA, Viral/blood
- DNA, Viral/economics
- Female
- Hepatitis B Surface Antigens/blood
- Hepatitis B e Antigens/blood
- Hepatitis B e Antigens/economics
- Hepatitis B virus/genetics
- Hepatitis B virus/immunology
- Hepatitis B, Chronic/blood
- Hepatitis B, Chronic/drug therapy
- Hepatitis B, Chronic/economics
- Hepatitis B, Chronic/transmission
- Humans
- Immunization, Passive/economics
- Infant, Newborn
- Infectious Disease Transmission, Vertical/economics
- Infectious Disease Transmission, Vertical/prevention & control
- Pregnancy
- Quality-Adjusted Life Years
- Serologic Tests/economics
- Vaccination/economics
- Viral Load/economics
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Affiliation(s)
- Lin Fan
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Owusu-Edusei K, Roby TM, Chesson HW, Gift TL. Productivity costs of nonviral sexually transmissible infections among patients who miss work to seek medical care: evidence from claims data. Sex Health 2014; 10:434-7. [PMID: 23987746 DOI: 10.1071/sh13021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 06/18/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Productivity losses can arise when employees miss work to seek care for sexually transmissible infections (STIs). We estimated the average productivity loss per acute case of four nonviral STIs: chlamydia, gonorrhoea, syphilis and trichomoniasis. METHODS We extracted outpatient claims from 2001-2005 MarketScan databases using International Classification Disease ver. 9 (ICD-9) codes. We linked claims with their absence records in the Health and Productivity Management database by matching enrolee identifiers and the service dates from the claims such that our final data included only those who were absent because they were sick and were diagnosed with an STI on the day of their visit. To ensure that the visit was for the STIs being examined, we restricted the criteria to records with the specified ICD-9 codes only, excluding claims with other codes. We estimated the average number of hours absent and multiplied it by the mean hourly wage rate including benefits ($29.72 in 2011 United States dollars) to estimate the average productivity loss per case. RESULTS The average productivity losses per case were: $262 for chlamydia, $197 for gonorrhoea, $419 for syphilis and $289 for trichomoniasis. There were no significant differences between males and females. CONCLUSIONS Among those who take sick leave to seek care, productivity losses associated with treating nonviral STIs may be higher than their estimated direct medical costs. These productivity cost estimates can help to quantify the overall STI burden, and inform cost-effectiveness analyses of prevention and control efforts.
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Affiliation(s)
- Kwame Owusu-Edusei
- Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road M/S E-80, Atlanta, GA 30333, USA
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Owusu-Edusei K, Roby T, Wright SS, Chesson HW. The consistency of relative incidence rates of nonviral sexually transmissible infections from health insurance claims and surveillance data, 2005-10. Sex Health 2014; 10:400-7. [PMID: 23849061 DOI: 10.1071/sh12191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 05/19/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Given the growing popularity of administrative data for health research, information on the differences and similarities between administrative data and customary data sources (e.g. surveillance) will help to inform the use of administrative data in the field of sexually transmissible infections (STIs). The objective of this study was to compare the incidence rates of three nonviral STIs from a large health insurance administrative database (MarketScan) with surveillance data. METHODS We computed and compared STI rates for 2005-10 from MarketScan and national surveillance data for three major nonviral STIs (i.e. chlamydia (Chlamydia trachomatis), gonorrhoea (Neisseria gonorrhoeae) and syphilis (Treponema pallidum)). For administrative data, we assessed the sensitivity of the rates to enrollee inclusion criteria: continuous (≥320 member-days) versus all enrollees. Relative rates were computed for 5-year age groups and by gender. RESULTS The administrative database rates were significantly lower (P<0.01) than those in the national surveillance data, except for syphilis in females. Gonorrhoea and syphilis rates based on administrative data were significantly lower (P<0.01) for all enrollees versus continuous enrollees only. The relative STI rates by age group from the administrative data were similar to those in the surveillance data. CONCLUSIONS Although absolute STI rates in administrative data were lower than in the surveillance data, relative STI rates from administrative data were consistent with national surveillance data. For gonorrhoea and syphilis, the estimated rates from administrative data were sensitive to the enrollee inclusion criteria. Future studies should examine the potential for administrative data to complement surveillance data.
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Affiliation(s)
- Kwame Owusu-Edusei
- Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road MS E-80, Atlanta, GA 30333, USA
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Chesson HW, Owusu-Edusei K, Leichliter JS, Aral SO. Violent crime rates as a proxy for the social determinants of sexually transmissible infection rates: the consistent state-level correlation between violent crime and reported sexually transmissible infections in the United States, 1981-2010. Sex Health 2014; 10:419-23. [PMID: 23987728 DOI: 10.1071/sh13006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 06/04/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Numerous social determinants of health are associated with violent crime rates and sexually transmissible infection (STI) rates. This report aims to illustrate the potential usefulness of violent crime rates as a proxy for the social determinants of STI rates. METHODS For each year from 1981 to 2010, we assessed the strength of the association between the violent crime rate and the gonorrhoea (Neisseria gonorrhoeae) rate (number of total reported cases per 100?000) at the state level. Specifically, for each year, we calculated Pearson correlation coefficients (and P-values) between two variables (the violent crime rate and the natural log of the gonorrhoea rate) for all 50 states and Washington, DC. For comparison, we also examined the correlation between gonorrhoea rates, and rates of poverty and unemployment. We repeated the analysis using overall syphilis rates instead of overall gonorrhoea rates. RESULTS The correlation between gonorrhoea and violent crime was significant at the P<0.001 level for every year from 1981 to 2010. Syphilis rates were also consistently correlated with violent crime rates. In contrast, the P-value for the correlation coefficient exceeded 0.05 in 9 of the 30 years for the association between gonorrhoea and poverty, and in 17 of the 30 years for that between gonorrhoea and unemployment. CONCLUSIONS Because violent crime is associated with many social determinants of STIs and because it is consistently associated with STI rates, violent crime rates can be a useful proxy for the social determinants of health in statistical analyses of STI rates.
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Affiliation(s)
- Harrell W Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Owusu-Edusei K, Sayegh BJ, Harvey AJ, Nelson RJ. Declining trends in the proportion of non-viral sexually transmissible infections reported by STD clinics in the US, 2000-10. Sex Health 2014; 11:340-4. [PMID: 25131645 DOI: 10.1071/sh14057] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/09/2014] [Indexed: 11/23/2022]
Abstract
UNLABELLED Background Recent budget shortfalls may have resulted in decreases in the number of sexually transmissible infections (STIs) reported from sexually transmitted disease clinics (STDCs) in the United States (US). The objective of this study was to examine the proportion of cases reported from STDCs for three non-viral STIs in the last decade. METHODS Data from the national surveillance database on primary and secondary (P&S) syphilis, gonorrhoea and chlamydia cases for 2000-10 were extracted. The percentage of cases reported by STDCs for the nation and for each of the 48 contiguous states were then computed. Finally, the χ(2) trend test for proportions was used to determine the annual average decrease/increase in the percentage of cases reported by STDCs for the nation and for each state. RESULTS RESULTS demonstrate that the average annual declines in the proportion of P&S syphilis, gonorrhoea, and chlamydia cases reported from STDCs were 1.43% (P<0.01), 1.31% (P<0.01), and 0.31% (P<0.01), respectively. Additionally, most of the states with statistically significant trends (P<0.05) in the proportion of cases reported by STDCs had negative slopes: 86% (25/29) for P&S syphilis, 89% (34/38) for gonorrhoea, and 63% (27/43) for chlamydia. CONCLUSION These results document the declining role of STDCs in STI prevention and control efforts in the US. Further studies are needed to assess the direct or indirect impact of the decline in the proportion of cases from STDCs on the overall STI control and prevention efforts in the US and its implications for the future.
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Affiliation(s)
- Kwame Owusu-Edusei
- Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road M/S E-80, Atlanta, GA 30333, USA
| | - Bianca J Sayegh
- Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road M/S E-80, Atlanta, GA 30333, USA
| | - Alesia J Harvey
- Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road M/S E-80, Atlanta, GA 30333, USA
| | - Robert J Nelson
- Division of STD Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road M/S E-80, Atlanta, GA 30333, USA
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Glasser JW, Owusu-Edusei K, Glick SN, Aral SO, Gift TL. O16.3 Controlling Chlamydia: Population Modeling to Assess Promising Interventions. Sex Transm Infect 2013. [DOI: 10.1136/sextrans-2013-051184.0175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Glasser JW, Chesson HW, Glick SN, Owusu-Edusei K, Gift TL, Aral SO. O20.3 Sex in Seattle: Mechanistic Modeling of Sexual Partnership Dynamics. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hart-Cooper G, Owusu-Edusei K, Chesson H, Hoover K. P3.435 Opt-Out Rectal Screening For Chlamydia and Gonorrhea in Young Men Who Have Sex with Men (YMSM). Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chesson H, Owusu-Edusei K, Kirkcaldy RD, Gift TL, Weinstock HS. P5.096 Estimating the Potential Economic Impact of Antimicrobial Resistance in Neisseria Gonorrhoeaein the United States. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.1140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Owusu-Edusei K, Hoover KW, Hart-Cooper GD, Gift TL. O06.5 An Exploratory Evaluation of Universal Opt-Out Chlamydia Testing During Clinical Encounters For Young Women in the United States. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Owusu-Edusei K, Chesson HW, Leichliter JS, Kent CK, Aral SO. The association between racial disparity in income and reported sexually transmitted infections. Am J Public Health 2013; 103:910-6. [PMID: 23488482 DOI: 10.2105/ajph.2012.301015] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association between racial disparity in income and reported race-specific county-level bacterial sexually transmitted infections (STIs) in the United States focusing on disparities between Blacks and Whites. METHODS Data are from the US 2000 decennial census. We defined 2 race-income county groups (high and low race-income disparity) on the basis of the difference between Black and White median household incomes. We used 2 approaches to examine disparities in STI rates across the groups. In the first approach, we computed and compared race-specific STI rates for the groups. In the second approach, we used spatial regression analyses to control for potential confounders. RESULTS Consistent with the STI literature, chlamydia, gonorrhea, and syphilis rates for Blacks were substantially higher than were those for Whites. We also found that racial disparities in income were associated with racial disparities in chlamydia and gonorrhea rates and, to a lesser degree, syphilis rates. CONCLUSIONS Racial disparities in household income may be a more important determinant of racial disparities in reported STI morbidity than are absolute levels of household income.
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Affiliation(s)
- Kwame Owusu-Edusei
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Owusu-Edusei K, Gift TL, Chesson HW, Kent CK. Investigating the potential public health benefit of jail-based screening and treatment programs for chlamydia. Am J Epidemiol 2013; 177:463-73. [PMID: 23403986 DOI: 10.1093/aje/kws240] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Observational studies have found mixed results on the impact of jail-based chlamydia screen-and-treat programs on community prevalence. In the absence of controlled trials or prospectively designed studies, dynamic mathematical models that incorporate movements in and out of jail and sexual contacts (including disease transmission) can provide useful information. We explored the impact of jail-based chlamydia screening on a hypothetical community's prevalence with a deterministic compartmental model focusing on heterosexual transmission. Parameter values were obtained from the published literature. Two analyses were conducted. One used national values (large community); the other used values reported among African Americans--the population with the highest incarceration rates and chlamydia burden (small community). A comprehensive sensitivity analysis was carried out. For the large-community analysis, chlamydia prevalence decreased by 13% (from 2.3% to 2.0%), and based on the ranges of parameter values (including screening coverage of 10%-100% and a postscreening treatment rate of 50%-100%) used in the sensitivity analysis, this decrease ranged from 0.1% to 58%. For the small-community analysis, chlamydia prevalence decreased by 54% (from 4.6% to 2.1%). Jail-based chlamydia screen-and-treat programs have the potential to reduce chlamydia prevalence in communities with high incarceration rates. However, the magnitude of this potential decrease is subject to considerable uncertainty.
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Affiliation(s)
- Kwame Owusu-Edusei
- Division of STD Preventions, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Rodriguez HP, Chen J, Owusu-Edusei K, Suh A, Bekemeier B. Local public health systems and the incidence of sexually transmitted diseases. Am J Public Health 2012; 102:1773-81. [PMID: 22813090 DOI: 10.2105/ajph.2011.300497] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the associations of local public health system organization and local health department resources with county-level sexually transmitted disease (STD) incidence rates in large US health jurisdictions. METHODS We linked annual county STD incidence data (2005-2008) to local health department director responses (n = 211) to the 2006 wave of the National Longitudinal Study of Local Public Health Systems, the 2005 national Local Health Department Profile Survey, and the Area Resource File. We used nested mixed effects regression models to assess the relative contribution of local public health system organization, local health department financial and resource factors, and sociodemographic factors known to be associated with STD incidence to county-level (n = 307) STD incidence. RESULTS Jurisdictions with local governing boards had significantly lower county-level STD incidence. Local public health systems with comprehensive services where local health departments shoulder much of the effort had higher county-level STD rates than did conventional systems. CONCLUSIONS More integration of system partners in local public health system activities, through governance and interorganizational arrangements, may reduce the incidence and burden of STDs.
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Affiliation(s)
- Hector P Rodriguez
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA.
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