Understanding Socioeconomic and Health Care System Drivers to Increase Vaccination Coverage

Understanding Socioeconomic and Health Care System Drivers to Increase Vaccination Coverage Jason Baumgartner Life Sciences Consulting Director, Quintiles April 2011

Discussion Topics Title: Understanding Socioeconomic and Health Care Systems Drivers to Increase Vaccination Coverage - Socioeconomic and Health Care System Trends - Case Studies Meningococcal HPV - Summary and Implications 2

Socioeconomic and Healthcare System Trends Expansion in Health Care Coverage / Preventive Medicine - Global trends in health care reform - Initiatives in US and China to cover all citizens Increasingly Heterogeneous Populations - Globalization and immigration - Multi-cultural cities and states Empowered Patient Voice - Influence through traditional and social media 4

Systematic Evaluation of Socioeconomic and Healthcare Factors After noticing a disparity of state vaccine coverage rates, we explored if socioeconomic and health care systems factors had any correlation - Socioeconomic Poverty Rate High School Graduation Rates Freshmen Graduation Rate Median Annual Household Income Health Insurance Coverage of Children Percentage Uninsured Children Who Attend Religious Services Weekly Percent of People Who Have Completed a Bachelor's Degree - Health Care System Health Care Expenditures per Capita Physicians per 1000 patients State Law Requirements Percentage on Medicaid OB / GYN per 1000 6

Meningococcal Adolescent ACWY (2009) Average Coverage Rate of 54% Washington Oregon Idaho Montana Wyoming North Dakota South Dakota Minnesota Wisconsin Michigan New York Vermont Maine New Hampshire Massachusetts Rhode Island Connecticut California Nevada Utah Colorado Nebraska Kansas Iowa sour Missouri Illinois Indiana Kentucky Ohio Pennsylvania West North Carolina New Jersey Washington D.C. Delaware Maryland Arizona New Mexico Oklahoma Arkansas Tennessee South Carolina Mississippi Alabama Georgia % by State 50 to 80 Texas Louisiana Florida 40 to 49 10 to 39 Source: CDC 2,600 people contract meningococcal disease yearly 7

Meningococcal Adolescent ACWY (2009) Average Coverage Rate of 54% Washington Oregon Idaho Montana Wyoming North Dakota South Dakota Minnesota Wisconsin Michigan New York Vermont Maine New Hampshire Massachusetts Rhode Island Connecticut California Nevada Utah Colorado Nebraska Kansas Iowa sour Missouri Illinois Indiana Kentucky Ohio Pennsylvania West North Carolina Washington D.C. 78% Arizona New Mexico Oklahoma Arkansas Mississippi Tennessee Alabama Georgia South Carolina Physicians per 1000 pts (4x higher) % by State 50 to 80 40 to 49 Texas Louisiana Florida % Completed a BS Degree (Leader) 10 to 39 Source: CDC 8

Meningococcal Adolescent ACWY (2009) Average Coverage Rate of 54% Washington Oregon Nevada California Idaho Utah Montana Wyoming Colorado North Dakota South Dakota Nebraska Kansas Minnesota Iowa sour Missouri Wisconsin Illinois Michigan Indiana Kentucky Ohio West New York Pennsylvania Vermont Maine New Hampshire 76% Massachusetts Rhode Island Rate by State 50 to 80 Arizona New Mexico Texas Oklahoma Arkansas Louisiana Mississippi Tennessee Alabama Georgia North Carolina South Carolina Florida Physicians per 1000 pts (TOP 5 ) Vaccinate Before You Graduate (school-based clinics) 40 to 49 10 to 39 Source: CDC 9

Correlation of Socioeconomic and Health Care System Factors on Meningococcal Coverage Poverty Rate Health Care Expenditures per Capita High School Graduation Rates Freshmen Graduation Rate Median Annual Household Income Percentage on Medicaid Children Health Insurance R 2 < 0.05 NO CORRELATION SOME CORRELATION State Law Requirements Uninsured Population Children Who Attend Religious Services Weekly 0.05 < R 2 < 0.25 HIGH CORRELATION Physicians Per 1000 Patients Percent Who Have Completed a Bachelor's Degree R 2 > 0.25 Optimize delivery channel (e.g., school based clinics) 10

HPV 1 st Dose of 3 Recommended (2009) Average Coverage Rate of 27% Washington Montana North Dakota Vermont Maine Oregon Idaho Wyoming South Dakota Minnesota Wisconsin Michigan New York New Hampshire Massachusetts Rhode Island Connecticut California Nevada Utah Colorado Nebraska Kansas Iowa sour Missouri Illinois Indiana Kentucky Ohio Pennsylvania West New Jersey Washington D.C. Delaware Maryland North Carolina Arizona New Mexico Oklahoma Arkansas Tennessee South Carolina Mississippi Alabama Georgia Rate by State Texas Louisiana Florida 50 to 70 40 to 49 20 to 39 10,800 new cases of HPV-associated cervical cancer are diagnosed in the United States each year. 11

HPV 1 st Dose of 3 Recommended (2009) Average Coverage Rate of 27% Washington Montana North Dakota Vermont Maine Oregon Idaho South Dakota Minnesota Wisconsin New York New Hampshire Massachusetts California Nevada Utah Arizona Wyoming Colorado New Mexico Nebraska Kansas Oklahoma Iowa sour Missouri Arkansas Illinois Mississippi Michigan Indiana Kentucky Tennessee Alabama Ohio Georgia Pennsylvania West North Carolina South Carolina 69% Uninsured (Lowest) Rate of OB/GYN Per patient (TOP 5) Percentage of Children Attending Religious Services (Bottom 5) Rate by State Texas Louisiana Florida 50 to 70 40 to 49 20 to 39 10,800 new cases of HPV-associated cervical cancer are diagnosed in the United States each year. 12

Impact of Socioeconomic and Health Care System Factors on HPV Coverage NO CORRELATION SOME CORRELATION HIGH CORRELATION HPV Legislation Uninsured Population Poverty Rate % of Married Couples Median Household Income Health Care Expenditures per Capita Health Insurance Coverage of Children 0-18, states High School Graduation Rate R 2 < 0.1 Teen Birth Rate Percent Who Have Completed a Bachelor's Degree OB / GYN per 1000 0.1 > R 2 < 0.4 Children Who Attend Religious Services Weekly, Percentage (Inverse relation) R 2 > 0.4 Address cultural and geographic variations Engage patients and influencers early and often 13

Health Care Architecture to Uncover Commercial Opportunity Commercial Process Perceptions Architecture Patient Influencers Traditional media DTC advertising Community groups Family/Friends Religious Institutions Channel Vaccination Community MD Payers Group Practice Private payers Public advocacy Government services Nurse Services Evolving business models Compliance Community Nurses Disease management Patient groups Payers 15

Implications for Changing the Map to Green Trends Expansion in Health Care Coverage Solution 1. Optimize delivery channel (school based clinics) Heterogeneous Populations 2. Address cultural and geographic variations Empowered Patient Voice 3. Engage patients and influencers early and often 16