Blue Cross Blue Shield of Michigan, Detroit.
J Manag Care Spec Pharm. 2024 Dec;30(12):1405-1413. doi: 10.18553/jmcp.2024.30.12.1405.
Human papillomavirus (HPV) results in 37,000 new cancers each year. HPV-attributable cancers are preventable through vaccination with the completion of the HPV series encouraged by age 13 years. Public uptake has been lower than expected. Blue Cross Blue Shield of Michigan (BCBSM) implemented clinical programs to address low vaccination rates.
To compare the proportion of adolescent members who completed the HPV vaccine series before vs after implementation of clinical programs.
Retrospective, observational study of BCBSM commercial medical claims for members aged 9 to younger than 14 years. Data were divided accordingly: (A) pre-intervention (2019), (B) academic detailing (2022), and (C) academic detailing and provider incentive (2023). Years 2020 and 2021 were excluded to avoid impact from the COVID-19 pandemic. The primary outcome compared the proportion of members who completed the HPV vaccine series for Cohorts B and C compared with Cohort A. Secondary outcomes included the proportion of members who completed the first dose, the time between the dose due date and when the dose was received, average age at series completion, and dose 1 and 2 completion by month. Data were assessed using chi-square and independent t-tests.
Member baseline characteristics were similar, with the majority aged 11 to younger than 13 years, male, White, and having an urban residence. For Cohorts A, B, and C, the proportion of HPV series completers were 15.3%, 15.2%, and 15.2%, respectively. The proportion of those who received only 1 dose was 15.8%, 15.6%, 15.5%, respectively. Cohorts B and C completed the series later compared with Cohort A, with the remaining time until due date as follows: 38 days (Cohort A), 8 days (Cohort B), and 4 days (Cohort C). Compared with Cohort A, Cohorts B and C had more members who received doses 1 and 2 more than 1 year apart: 8.1% (Cohort B) and 8.4% (Cohort C) compared with 6.3% (Cohort A). The average age of series completion was 12 years. August was the most popular month to receive doses 1 and 2 across all cohorts.
The difference observed between cohorts for the proportion of members who completed the series was not statistically significant. Cohorts B and C completed the series later compared with Cohort A, and a higher proportion received doses 1 and 2 more than 1 year apart. Although the years 2020 and 2021 were not included, lasting impact from the pandemic may have influenced study results; however, BCBSM's efforts may have mitigated the impact of the national decrease seen in HPV vaccination among in-state members.
人乳头瘤病毒（HPV）每年导致 3.7 万例新癌症。通过在 13 岁之前完成 HPV 系列疫苗接种，可以预防 HPV 相关癌症。公众接种率低于预期。密歇根蓝十字蓝盾（BCBSM）实施了临床项目，以解决疫苗接种率低的问题。
比较实施临床项目前后，青少年成员完成 HPV 疫苗系列接种的比例。
对 BCBSM 商业医疗索赔数据进行回顾性、观察性研究，对象为 9 岁以下至 14 岁以下的成员。数据分为以下几部分：（A）干预前（2019 年），（B）学术详述（2022 年）和（C）学术详述和提供者激励（2023 年）。排除 2020 年和 2021 年，以避免 COVID-19 大流行的影响。主要结局比较了队列 B 和 C 与队列 A 相比，完成 HPV 疫苗系列接种的成员比例。次要结局包括完成第一剂的成员比例、剂量到期日与实际接种剂量之间的时间间隔、系列完成时的平均年龄以及按月完成第一剂和第二剂的比例。使用卡方检验和独立 t 检验评估数据。
成员的基线特征相似，大多数为 11 岁以下至 13 岁，男性，白人，居住在城市。对于队列 A、B 和 C，HPV 系列完成者的比例分别为 15.3%、15.2%和 15.2%。仅接受一剂疫苗的比例分别为 15.8%、15.6%和 15.5%。队列 B 和 C 比队列 A 更晚完成系列接种，截至日期前的剩余时间分别为：38 天（队列 A）、8 天（队列 B）和 4 天（队列 C）。与队列 A 相比，队列 B 和 C 有更多成员在第一剂和第二剂之间间隔超过 1 年：8.1%（队列 B）和 8.4%（队列 C）与 6.3%（队列 A）。系列完成的平均年龄为 12 岁。8 月是所有队列中接受第一剂和第二剂的最受欢迎月份。
观察到各队列之间在完成系列接种的成员比例方面没有统计学意义的差异。队列 B 和 C 比队列 A 更晚完成系列接种，并且更多成员接受第一剂和第二剂的时间间隔超过 1 年。尽管没有包括 2020 年和 2021 年，但全国 HPV 疫苗接种率下降可能对研究结果产生持久影响；然而，BCBSM 的努力可能减轻了州内成员 HPV 疫苗接种率下降的影响。
