Zhou Fangjun, Shefer Abigail, Weinbaum Cindy, McCauley Mary, Kong Yuan
National Center for Immunization and Respiratory Diseases (NCIRD), Centers for Disease Control and Prevention (CDC), Atlanta, GA 30333, United States.
Vaccine. 2007 May 4;25(18):3581-7. doi: 10.1016/j.vaccine.2007.01.081. Epub 2007 Jan 25.
Since 1996, hepatitis A vaccine has been recommended for persons at risk for infection and children living in communities with the highest disease rates. In 1999, this recommendation was expanded to include all children in 17 states with high incidence compared to a national baseline period. Reported hepatitis A incidence has decreased substantially since 1999; however, comprehensive data on changes in hospital and outpatient utilization have not been reported.
To analyze a health insurance claims database to examine impacts of the hepatitis A vaccination program on medical visits and associated expenditures.
We conducted a retrospective study of the 1996-2004 Medstat MarketScan databases, which include enrollees of more than 100 health insurance plans offered by approximately 40 large employers each year, using 1996 and 1997 as the pre-vaccination baseline. Trends in rates of medical care visits were analyzed using Poisson regression method.
From the pre-vaccination era to 2004, hospitalizations due to hepatitis A declined by 68.5% (from 0.81 to 0.26 per 100,000 population, P<0.001) and ambulatory visits declined by 41.5% (from 12.9 to 7.5 per 100,000 population, P<0.001). Ambulatory visits declined in all age groups, with the greatest declines among children<18 years old. Declines were greater among enrollees who resided in the 17 vaccinating states (58.5%) than those in non-vaccinating states (32.7%, P<0.001). After adjusting to the US population, using data derived from a privately insured population, total estimated direct medical expenditures for hepatitis A-related hospitalizations and ambulatory visits declined by 68.1%, from an average of $29.1 million in 1996 and 1997 to $9.3 million in 2004.
Since the introduction of the hepatitis A vaccination program, hospitalizations, ambulatory visits, and their associated expenditures due to hepatitis A disease have declined substantially among all age groups across the US. Greater declines were seen in the 17 states with vaccination recommendations for hepatitis A.
自1996年以来，甲型肝炎疫苗已被推荐用于感染风险人群以及生活在发病率最高社区的儿童。1999年，这一推荐范围扩大至17个发病率高于全国基线水平的州的所有儿童。自1999年以来，报告的甲型肝炎发病率大幅下降；然而，关于住院和门诊利用情况变化的综合数据尚未见报道。
分析一个医疗保险理赔数据库，以研究甲型肝炎疫苗接种计划对就诊和相关支出的影响。
我们对1996 - 2004年的Medstat MarketScan数据库进行了一项回顾性研究，该数据库每年包含约40家大型雇主提供的100多种医疗保险计划的参保者，以1996年和1997年作为接种疫苗前的基线。使用泊松回归方法分析医疗就诊率的趋势。
从接种疫苗前的时期到2004年，甲型肝炎导致的住院率下降了68.5%（从每10万人0.81例降至0.26例，P<0.001），门诊就诊率下降了41.5%（从每10万人12.9次降至7.5次，P<0.001）。所有年龄组的门诊就诊率均下降，其中18岁以下儿童下降幅度最大。居住在17个实施疫苗接种州的参保者的下降幅度（58.5%）大于未实施疫苗接种州的参保者（32.7%，P<0.001）。利用来自私人参保人群的数据对美国人口进行调整后，甲型肝炎相关住院和门诊就诊的估计直接医疗总支出下降了68.1%，从1996年和1997年的平均2910万美元降至2004年的930万美元。
自甲型肝炎疫苗接种计划实施以来，美国所有年龄组中因甲型肝炎疾病导致的住院、门诊就诊及其相关支出均大幅下降。在17个对甲型肝炎有疫苗接种推荐的州下降幅度更大。
