High Deductible Health Plan Study Featured in NYT “Your Money”

In a recent New York Times “Your Money” column, DPM researcher Frank Wharam, MB, BCh, BAO, MPH discusses the results of his recently published Medical Care article, which found that of subscribers in high-deductible health care plans, men are more likely than women to avoid necessary medical care.  Since the Affordable Care Act is expected to increase the number of people enrolled in high-deductible plans, enrollment in plans that have high out-of-pocket costs could further reduce use of health care services among men.

The NYT columnist reflects on the gender differences cited in Dr. Wharam’s study and offers men on high-deductible plans some questions to consider when deciding to seek medical care.  Alison Galbraith, MD, MPH, also a contributor to the article, suggests men engage their physicians in conversation about the cost of medical care, and whether cheaper, alternative treatments are available.

To read the full New York Times article, click here.

To read Dr. Wharam’s study abstract, click here.

Increased risk of intussusception following rotavirus vaccination in infants

Rotavirus infection causes diarrheal disease, mostly in infants, and was associated with more than 600,000 deaths each year globally prior to the availability of vaccine.  Rotashield, an infant rotavirus vaccine licensed in 1998, was voluntarily withdrawn from the market within a year when an increased risk of intussusception, a rare kind of intestinal blockage, after vaccination was discovered.  Two newer rotavirus vaccines, RotaTeq and Rotarix, were licensed in the U.S. in 2006 and 2008, respectively, after large clinical trials designed to be able to detect an excess risk of intussusception similar to that of Rotashield (approximately 1-1.5 excess cases per 10,000 vaccine recipients).  Although no such risk was observed in the clinical trials, several postlicensure studies conducted in other countries subsequently suggested an increased risk of intussusception after both Rotarix and RotaTeq. 
 
In 2010, the FDA, through Mini-Sentinel’s Post-licensure Rapid Immunization Safety Monitoring (PRISM) project, launched a large population-based study to quantify the risk of intussusception after rotavirus vaccination among U.S. infants. The study, led by Katherine Yih, PhD, MPH, found evidence of an association between one of the rotavirus vaccines, RotaTeq, and intussusception, with the highest risk occurring in the 3-7 days after the first dose.  The risk was estimated at approximately 1.1-1.5 excess cases per 100,000 first-dose recipients, or about 1/10 the risk associated with the original, discontinued vaccine, Rotashield.  Based on published data, the benefit of the vaccine in preventing hospitalizations and deaths from diarrheal disease continues to outweigh the risk of intussusception.  
 
As a result of this study, the FDA approved a change to the RotaTeq product label.  Dr. Yih presented the findings to the Advisory Committee on Immunization Practices (ACIP) in June, which is evaluating them together with results of other recent studies but does not foresee major changes in rotavirus vaccination policy.
 
The full report is posted to the Mini-Sentinel Website.