1. Using Medical Claims Data for Timely Estimation of Rotavirus Vaccine Coverage Lone Simonsen, George Washington University and SDI Farid Khan and Laurel Edelman, SDI 44th National Immunization Conference, Atlanta April 19, 2010

2. 2 Background  Current Tracking Vaccine Coverage of new pediatric vaccines in R outine Infant Schedule could be improved  National Immunization Survey  Data lag by several years  Immunization Sentinel Sites (ISS) Surveillance  Private sector e-claims databases to the rescue?  Improve reporting timeliness  Very large sample size  Automatic tracking - surveillance  Flexibility (age, geography, gender, risk groups….)  Dose uptake patterns at high spatial/temporal granularity

3. 3 Others are thinking about this too….. Kalies et al, BMC-PH 2008 (Germany)

4. 4 Private Sector Electronic Data Sources  Medical Claims CMS-1500 data  Vaccine doses administered are indicated by  CPT procedure code  (ICD9-coded data can be used to track disease)  Example: Tracking Infant Rotavirus vaccine coverage 2006-2010  Rotateq – introduced 2006 CPT code: 90680  Rotarix – introduced 2008 CPT code: 90681

5. 5 2. Using CMS-1500 Office Visit Claims Data to track influenza vaccine administration in physician offices Doctor sees patient, codes diagnoses and procedures on claim form, submits claim electronically “Switch” directs claim to correct payer SDI incorporates de-identified HIPAA-compliant CMS-1500 records into data warehouse Link with synthetic ID patient key Payer processes claim Timeliness: 1-2 weeks lag Sample Size: ~50% of all outpatient visits, 300,000 physicians Representativeness: All States; Medicare, Medicaid, Private payers $ Analyzes CPT (procedure) codes listed for Vaccine

6. 6 The VFC Challenges  Challenge: Only “paying” children get CPT procedure codes  Vaccine for Children (~50% of all US kids) are not “seen” in these databases  Thus, the CMS-1500 claims data exclusively tracks private sector immunizations administered in physician’s office setting

7. 7 SDI-CDC Rotavirus Collaboration: Objective  Aim: To utilize CMS-1500 data to generate timely estimates of Rotavirus vaccine uptake  By season, infant age groups, US regions  Strategy  Develop methodology that overcomes VFC challenge  Use DTaP “stable vaccine” as benchmark for national est  Validate against CDC estimates  Sentinel Immunization Sites  National Immunization Survey NIS (eventually)  Support Phase IV evaluation of Rota vaccine program  Demonstrate direct and indirect vaccine benefits as a reduction in diarrheal illness; use ICD-coded diagnoses  “Ecological” study design

8. 8 Creating Patient-level Longitudinal Records from the Visit Data, using de-identified patient key 2mo baby well visit 4mo baby well visit 6mo baby well visit Record presence of vaccine CPT codes: - Dose Number, Age and Date Denominator: All infants with DTaP CPT code 0-6mo of age - If no DTaP CPT, this is a VFC child (eliminate) Linked by patient synthetic ID Other visit Other visit

9. 9 Age Cohort Model % Rotateq coverage during May-Oct2006 Adjustment: benchmark with DTaP coverage Tight denominator: Infants with >=1 DTaP CPT code in first 6 months of life

10. 10 Results, Evolution of Rotateq 1+ DOSE, 2006-08 by age during first two winter periods Month of administration during 2006-2008

11. 11 Rotateq 2+ DOSE coverage, 2006-08 by age, for first two winter periods Month of administration during 2006-2008

12. 12 Evaluating the Benefits of the Emerging Rotateq Vaccination program Low, late rotavirus diarrhea Epidemic in 1 st season w decent coverage + Herd Immunity Vaccine 2+ DOSE Coverage in infant cohorts, 2006-08

13. 13 Age CDC Rotateq coverage est, Immunization Sentinel Sites Dec’07 Source: MMWR, October 23, 2009 National Immunization Survey (NIS) 3mo olds, 1 st dose 58% Data Not Yet Available Validating: CDC Data on 1+ dose coverage estimates at 3 months of Age, December 2007

14. 14 CDC-SDI collaboration Cortese et al, PIDJ, 2010

15. 15 Conclusion  Private sector has much to offer in terms of tracking vaccine dose administrations and vaccine coverage in near real time  We have demonstrated for Rotateq vaccine coverage, but the approach could be applied to tracking coverage for ANY emerging infant schedule vaccine

16. 16 Acknowledgments  Thanks to our CDC colleagues who have been working with us to develop and validate the use of claims data to track rotavirus vaccine coverage  Umesh Parashar, Margaret Cortese, Jackie Tate  Thanks to ~600 SDI staffers who identified, purchased, cleaned, processed, and maintained the CMS-1500 medical claims database Support: CDC Questions? Lone Simonsen lone@gwu.edulone@gwu.edu Laurel Edelman ledelman@sdihealth.com