Trends in Healthcare Utilization for Diarrhea and Rotavirus Disease in Privately Insured US Children <5 Years of Age, 2001-2006

Background: To assess impact of the new US rotavirus immunization program initiated in 2006, robust baseline data on diarrhea and rotavirus disease burden are needed. While several studies have assessed burden in inpatient settings, few data are available for emergency department (ED) and outpatient settings. Methods: We used the MarketScan databases, a large claims-based data repository, to analyze the health and economic burden of diarrhea-related healthcare encounters in children <5 years in inpatient, ED, and outpatient settings from 2001 to 2006. Because rotavirus testing and coding are not routinely performed, rotavirus burden was estimated by calculating excess diarrhea events during winter compared with summer baseline (winter residual method). Results: Between 2001 and 2006, the average annual rate of healthcare utilization for diarrhea was 1561 per 10,000 children <5 years, with a hospitalization rate of 50 per 10,000, ED visit rate of 180 per 10,000, and outpatient visit rate of 1332 per 10,000. The winter residual method attributed 53% of inpatient, 41% of ED, and 23% of outpatient diarrhea events to rotavirus. By age 5, we estimated that I in 74 children are admitted, I in 27 require ED care, and I in 7 are treated in outpatient settings for rotavirus illness. Median payments for rotavirus in inpatient, ED, and outpatient settings were $3135, $332, and $90, respectively. Conclusions: Rotavirus causes substantial health and economic burden in US children, especially in ED and outpatient settings. Future monitoring through claims-based data sources should allow assessment of rotavirus vaccine impact on healthcare utilization for diarrhea.