(335) Claims Profile Review to Assess Age at Vaccination Among Young Males Who Appeared to Receive the 4-valent Human Papillomavirus (HPV) Vaccine (4vHPV vaccine) in the United States

Background: In the US, the 4-valent human papillomavirus (HPV) vaccine (4vHPV vaccine), was licensed for males in October 2009 and may be given to those 9 through 26 years of age to prevent several HPV-related diseases. The 4vHPV vaccine was a 3-dose regimen.

Objectives: To assess whether the claim for 4vHPV administration on the index date was consistent with receipt of the vaccine among males less than 9 years of age.

Methods: Using Optum’s US-based commercial health insurance claims database, males vaccinated with the 4vHPV vaccine were identified by its specific procedure code . A random sample of 5 children at each age less than 9 years (N=5 children/year*9 years=45 children) was generated for a detailed review of claims profiles. The profiles included all available claims for each young male. A set of operational rules were used to separate profiles based on degree of support for 4vHPV receipt. If the profile included a subsequent office visit that also had a claim for 4vHPV vaccine (i.e., another dose), the profile was considered to support 4vHPV administration. If there was a subsequent office visit where the child received other vaccines but not 4vHPV (i.e., the child had the opportunity to receive another dose, but did not), the profile was considered to not support 4vHPV administration. If there were no further office visits at which vaccines were administered, or no additional visits according to the recommended schedule of 4vHPV, the profile was considered insufficient to assess.

Results: Of the 106,110 males who received a claim for 4vHPV administration, 186 were less than 9 years of age (0.18%). Among the random sample of 45 males, the claims profiles indicated that 6 (13%) were supportive of 4vHPV vaccination. The average age of males in this category was 6.7 years (range 4 to 8 years). Twenty-seven (60%) of the claims profiles were not supportive of 4vHPV vaccination, and these may represent coding errors. The average age of the 27 males in this category was 3.3 years (considerably younger than the supportive category). Claims profiles for 12 of the 45 males (27%) had insufficient information to assess 4vHPV vaccination.

Conclusions: Based on the review of the claims profiles for males who were below the labeled age for 4vHPV vaccine administration, at least half and potentially up to 87% (combining not supported with insufficient information categories) may represent coding errors. Those profiles supporting 4vHPV administration derive mainly from the children closer to 9 years of age where the choice to administer 4vHPV vaccine might be more plausible. A review of chronologic listing of health insurance claims (claims profiles) can provide insight into unexpected patterns of healthcare where coding errors are likely to be more common and can serve as a useful quality control approach.