Rotavirus vaccination associated with decreased rates of health care utilization

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1. Compared with pre-vaccine rates, this retrospective study found rotavirus-coded hospitalizations decreased as rotavirus vaccination rates of US children increased.

2. Increased rotavirus vaccination use was associated with decreased rates of diarrhea-related health care utilization by both vaccinated and unvaccinated children.

Evidence Rating Level: 2 (Good)

Study Rundown: Until the routine use of rotavirus vaccines RV5 (pentavalent vaccine, recommended in 2006) and RV1 (monovalent vaccine, recommended in 2008), rotavirus was the most common cause of severe gastroenteritis in young US children. Until this study, the impact and efficacy of the RV5 vaccine had most recently been studied through the 2008-2009 rotavirus season. This study attempted to provide updated information on the vaccination rate, effectiveness, benefits, and health  care use of young patients following rotavirus vaccination by comparing pre- (2001-2006) and post-vaccination (2007-2011) rates of diarrhea-related health care utilization among US children. Overall, vaccine coverage correlated with reduced rotavirus-coded hospitalization rates in children aged 3 to 59 months. In addition, the authors found indirect benefits of rotavirus vaccination in age qualified, unvaccinated children. Specifically, the unvaccinated cohort also saw a reduction in rotavirus-coded hospitalizations, though it was not as great as that seen in vaccinated children. The study also revealed an estimated multi-million dollar reduction in diarrhea-associated health care costs as a result of rotavirus vaccination. Though this study included a large sample size across most states, it lacked specific demographic information that would allow for more detailed analysis. This study contributes to the evaluation of the impact and benefits of rotavirus vaccination.

Click to read the study in Pediatrics

Relevant Reading: Diarrhea- and rotavirus-associated hospitalizations among children less than 5 years of age: United States, 1997 and 2000

Study Author, Dr. Eyal Leshem, MD, talks to 2 Minute Medicine: National Center for Immunization and Respiratory Diseases, and Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA.

“With increasing rotavirus vaccine coverage during 2009-2011, we observed continued reductions in rotavirus-coded hospitalizations and in all diarrhea-associated hospitalizations, emergency department and outpatient visits and associated costs.

Both rotavirus vaccines conferred high protection against rotavirus hospitalizations; pentavalent rotavirus vaccine provided durable protection through the fourth year of life.”

In-Depth [Retrospective cohort study]: This retrospective cohort study identified diarrhea-associated health care events from claims data taken out of the 2001-2011 Truven Health MarketScan database of insurance claims from public and private health plans, excluding Medicaid. Greater than 406000 children under 5 years of age from 37 states were included in this analysis. Diarrhea-associated hospitalizations, ED visits and outpatient visits were divided into pre-vaccine (2001-2006) and post-vaccine (2007-2011) groups, and compared. By 2010, vaccination rates of children 19-35 months were up to 59%. The most recent data for the 2010-2011 rotavirus season revealed a 92% rate reduction in rotavirus-coded hospitalizations in patients receiving the RV5 vaccine and a 96% reduction in patients receiving the RV1 vaccine when compared to those who were unvaccinated (CI= 95%). The rates of diarrhea-associated hospitalizations and ED visits decreased during this season compared to the baseline 2001-2006 pre-vaccine data (RR= 55% and 35% for RV5, respectively, CI=95%). Vaccination also revealed benefits for unvaccinated children, indicated by a reduction of 50%, 77% and 25% in rates of rotavirus-coded hospital visits in this group during 2007-2008, 2009-2010, 2010-2011, respectively (CI= 95%). Finally, the study revealed an estimated reduction in health care utilization costs of $924 million over the 4 year post-vaccine period, using estimated values of averted hospitalizations and median payment data for diarrhea associated hospitalizations in the MarketScan database.

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