Pregnant women with suspected Zika virus infection: A claims data analysis

Abstract

ObjectiveDemonstrate the value of consolidated claims data from communityhealthcare providers in Zika Virus Disease surveillance at local level.IntroductionZika virus disease and Zika virus congenital infection arenationally notifiable conditions that became prominent recently as agrowing number of travel-associated infections have been identifiedin the United States. The Centers for Disease Control and Prevention(CDC) have dedicated significant time and effort on determining andaddressing the risks and impact of Zika on pregnant women and theirbabies who are most vulnerable to the disease. CDC relies on twosources of information, reported voluntarily by healthcare providers,to monitor Zika virus disease: ArboNET and the newly establishedU.S. Zika Pregnancy Registry. A study by IMS Health compared U.S.trends of the Zika virus disease in general and pregnant women withZika virus disease in particular observed in an IMS healthcare claimsdatabase and the CDC ArboNET and the newly established U.S. ZikaPregnancy Registry.MethodsIMS used for this analysis claims for reimbursement from office-based healthcare providers, which are widely accepted standardbusiness practice records throughout the healthcare industry. IMSclaims data is collected daily from office-based providers throughoutthe U.S. and processed, stored and analyzed in a centralized database.The information is available at the patient and visit level, with theability to characterize deidentified patients by age, gender andZIP3 location and to trace a patient’s history of visits, diagnoses,procedures, drugs prescribed and tests performed or ordered.The general IMS study sample captured all patients throughout thecontinental United States covered in claims between October 1, 2016and May 24, 2016 with ICD 10 diagnosis code A92.8, Other SpecifiedMosquito-Borne Viral Fevers. This sample was compared to thesample of laboratory-confirmed Zika virus disease cases reportedto ArboNET by state or territory from the CDC Arboviral DiseaseBranch from January 1, 2015 through May 18, 2016. In addition,IMS compared the subset of patients with both a Zika virus diseasediagnosis and any ICD 10 pregnancy diagnosis to the CDC sampleof patients captured by the U.S. Zika Pregnancy Registry with anylaboratory evidence of possible Zika virus infection in the UnitedStates and territories.ResultsThroughout the continental United States, the IMS claims-basedsample captured 875 patients with a Zika virus disease diagnosiscompared to 548 travel-associated cases reported by CDC. At thestate level, especially in New York, New Jersey, Illinois and Texas,the IMS data captured a much larger number of cases that the CDCreported cases. Most of these possible Zika cases are concentratedin the large metropolitan areas around New York City, Chicagoand Houston. Many of them are diagnosed and treated by the samehealthcare providers.The IMS sample captured 577 pregnant women with a possibleZika virus infection compared to the 168 pregnant women with apossible Zika virus infection reported in the U.S. Zika PregnancyRegistry as of May 24, 2016. Many of the pregnant women in the IMSsample had multiple visits, often in consecutive months, associatedwith the Zika virus disease diagnosis. Pregnant women are morelikely to be tested and diagnosed with a Zika virus infection due tothe risk of fetal malformations from the disease. As many as 250 ofthe 577 pregnant women with a possible Zika virus infection also hada diagnosis of suspected fetal damage due to a viral disease. Of allwomen with a possible Zika virus infection in the IMS sample, 120were in New Jersey, 111 in New York, 93 in Illinois and 74 in Texas,and most were concentrated in the large metropolitan areas aroundNew York City, Chicago and Houston.ConclusionsThese findings suggest that all-payer claims data can be usedsuccesfully to monitor Zika transmission trends at local and statelevel, especially with a focus on pregnant women. Healthcare claimsdata is fast, granular, relevant at local level and can be used tosupplement CDC ArboNET data for local and state level surveillanceand response to the evolving Zika virus infection outbreak. Thisstudy is an example of a novel approach to surveillance for Zika virusdisease and potentially many other infectious diseases.