An Evaluation of Algorithms for Identifying Metastatic Breast, Lung, or Colorectal Cancer in Administrative Claims Data.

BACKGROUND: Administrative health care claims data are used for epidemiologic, health services, and outcomes cancer research and thus play a significant role in policy. Cancer stage, which is often a major driver of cost and clinical outcomes, is not typically included in claims data. OBJECTIVES: Evaluate algorithms used in a dataset of cancer patients to identify patients with metastatic breast (BC), lung (LC), or colorectal (CRC) cancer using claims data. METHODS: Clinical data on BC, LC, or CRC patients (between January 1, 2007 and March 31, 2010) were linked to a health care claims database. Inclusion required health plan enrollment ≥3 months before initial cancer diagnosis date. Algorithms were used in the claims database to identify patients' disease status, which was compared with physician-reported metastases. Generic and tumor-specific algorithms were evaluated using ICD-9 codes, varying diagnosis time frames, and including/excluding other tumors. Positive and negative predictive values, sensitivity, and specificity were assessed. RESULTS: The linked databases included 14,480 patients; of whom, 32%, 17%, and 14.2% had metastatic BC, LC, and CRC, respectively, at diagnosis and met inclusion criteria. Nontumor-specific algorithms had lower specificity than tumor-specific algorithms. Tumor-specific algorithms' sensitivity and specificity were 53% and 99% for BC, 55% and 85% for LC, and 59% and 98% for CRC, respectively. CONCLUSIONS: Algorithms to distinguish metastatic BC, LC, and CRC from locally advanced disease should use tumor-specific primary cancer codes with 2 claims for the specific primary cancer >30-42 days apart to reduce misclassification. These performed best overall in specificity, positive predictive values, and overall accuracy to identify metastatic cancer in a health care claims database.

Impact of osteoporosis on high-cost chronic diseases.

OBJECTIVE: To assess the impact of osteoporosis on health care costs for patients with chronic disease (CD): cardiovascular disease (CVD), chronic obstructive pulmonary disease (COPD), depression, diabetes mellitus (DM), or two or more of these CDs. METHODS: This retrospective analysis included commercially insured or Medicare Advantage male and female members aged 50 years or older with medical and pharmacy benefits who had evidence of osteoporosis and/or one of the CDs during the identification period (January 1, 2007, to October 31, 2009). Cohorts were defined by the presence or absence of osteoporosis and CD (osteoporosis ONLY, CD ONLY, and CD plus osteoporosis) and, for osteoporosis cohorts, by incident (recent diagnosis) or prevalent osteoporosis (long-standing). Primary outcome was total health care costs during 1-year follow-up. Costs, adjusted for baseline characteristics, were analyzed with a generalized linear model with log link and gamma distribution. RESULTS: Of the 494,160 patients, the majority had evidence of CD with or without osteoporosis: CVD (54%), two or more CDs (24%), DM (8%), depression (4%), COPD (1%); 9% had osteoporosis ONLY. The range of actual mean costs was as follows: CD ONLY, $8,377 (CVD) to $12,801 (two or more CDs); CD plus incident osteoporosis, $15,696 (CVD) to $23,860 (two or more CDs); CD plus prevalent osteoporosis, $10,038 (CVD) to $17,997 (two or more CDs). Compared with CD ONLY, baseline-adjusted costs were 66% (two or more CDs) to 91% (DM) higher for CD plus incident osteoporosis and 13% (CVD) to 23% (depression) higher for CD plus prevalent osteoporosis (P < 0.001). CONCLUSIONS: The burden of osteoporosis in patients with CD is significant, particularly for patients with newly diagnosed osteoporosis.

Clinical progression, acute urinary retention, prostate-related surgeries, and costs in patients with benign prostatic hyperplasia taking early versus delayed combination 5α-reductase inhibitor therapy and α-blocker therapy: a retrospective analysis.

BACKGROUND: Two previous retrospective database analyses compared early combination therapy with an α-blocker (AB) and 5-α reductase inhibitor (5-ARI) to delayed combination therapy and found that patients receiving the delayed combination therapy were more likely to have clinical progression, acute urinary retention (AUR), and surgery. Although these studies indicate the clinical benefits of early treatment, both studies failed to take into account important baseline clinical measures, such as prostate-specific antigen (PSA) values. OBJECTIVE: This study was designed to compare clinical and cost differences in men with benign prostatic hyperplasia (BPH) who initiated early versus delayed combination therapy with a 5-ARI + an AB, factoring in baseline PSA values. METHODS: This retrospective claims data analysis assessed data from >14 million US men with linked medical data, pharmacy data, laboratory results, and enrollment information from January 1, 2000, to December 31, 2009. Men aged 50 or older and treated for BPH with a 5-ARI + an AB were identified. Patients were required to be eligible for services at least 6 months before and 12 months after the index medication date. Patients were assigned to 1 of 2 treatment groups based on therapy (early or delayed) and 3 cohorts based on availability of PSA laboratory values (patients with a PSA value, patients with a PSA value >1.5 and <10, and all patients). Using a logistic model, the likelihood of clinical progression (defined as the occurrence of AUR or prostate surgery) during the 12 months after the date of first prescription fill was compared between BPH patients receiving early versus delayed combination therapy. BPH-related medical costs (excluding pharmacy costs) were assessed using generalized linear models. RESULTS: Among the 13,551 patients identified for study inclusion, the highest risks for clinical progression, AUR, and prostate-related surgery were consistently demonstrated in patients with a PSA >1.5 and <10. Across all 3 cohorts, the delayed combination-treatment group was more likely to have clinical progression, AUR, and prostate-related surgeries versus the early combination-treatment group. The incremental difference in BPH-related costs between the delayed and early combination-treatment groups was $190 per patient overall; the greatest incremental difference ($397) was observed in patients with PSA >1.5 and <10. CONCLUSIONS: The results suggest that early initiation of combination therapy with 5-ARI + an AB, compared with delayed initiation, can reduce the risks for clinical progression, AUR, and prostate-related surgeries, as well as BPH-related medical costs, in patients with BPH.

Community-acquired pneumonia episode costs by age and risk in commercially insured US adults aged ≥50 years.

BACKGROUND: Community-acquired pneumonia (CAP) causes substantial clinical and economic burden. While several studies have reported the cost to treat CAP, there is little information on the cost to treat by age, risk profile, and hospitalization in US adults aged ≥50 years. OBJECTIVE: To quantify the cost, from a payer perspective, of treating CAP at the episode level, stratified by age, risk profile, and hospitalization. METHODS: A retrospective study of claims data from a large US health plan (1 January 2006-31 December 2008) was conducted. Patients aged ≥50 years having at least one medical claim with a primary diagnosis for pneumonia were identified. A CAP episode was defined as the period between the first and last pneumonia ICD-9 code with a chest X-ray claim. Episode-level variables included risk stratum based on presence of an immunocompromising/chronic condition, age group, number and length of inpatient and outpatient CAP episodes, and all-cause and CAP-related healthcare costs (adjusted to 2011 costs). RESULTS: Among the 27,659 study patients, 28,575 CAP episodes (20,454 outpatient; 8,121 inpatient) occurred. Mean age of patients with a CAP episode was 62.6. Low-risk patients accounted for 44.4 % of all CAP episodes. Mean CAP episode length was 31.8 days for an inpatient episode and 10.2 days for an outpatient episode. Mean all-cause total healthcare cost for an inpatient CAP episode ranged from $11,148 to $51,219 depending on risk stratum and age group. Mean outpatient episode-related costs were much lower than inpatient episode-related costs. CONCLUSIONS: Cost to treat CAP requiring hospitalization is high regardless of age or the presence of underlying comorbidities. Given that almost half of the patients in this study did not have traditional risk factors for CAP, it is clear that better preventative strategies are needed.

Costs and clinical outcomes associated with use of ranolazine for treatment of angina.

BACKGROUND: There are 10 million patients with angina in the United States (500,000 new diagnoses annually). Although clinical efficacy of angina treatments is understood, total costs of care and clinical outcomes for patients with chronic angina in different treatment protocols are unknown. OBJECTIVE: Our objective was to estimate total costs of care and revascularization rates for patients with poorly controlled angina who added either (1) long-acting nitrates, (2) beta blockers or calcium channel blockers, or (3) ranolazine to their therapy. STUDY DESIGN: We performed retrospective claims analysis using an index event involving change of therapy in which a new antiangina drug was added. METHODS: Using a large commercial insurance claims database, 4545 patients with angina with an index event (ie, change of antiangina therapy) and 6 months of continuous enrollment pre- and postindex event were identified. Using total cost of care and revascularization rates, we first compared preindex disease burden, medical care use, and total cost of care and components of total cost. We then compared unadjusted use and cost of care across treatment groups. Finally, we estimated regression models to predict postindex event total costs of care and revascularization rates. RESULTS: During the preindex period, the 3 comparison groups had similar health measures, medical care use, and total costs of care. During the postindex period, ranolazine users had lower revascularization rates (9.9%) than comparison patient groups (15.4%-20.4%, both Ps < 0.001). Ranolazine users had lower total costs of care ($13,961) than the nitrate group ($18,166, 30.0% higher; P < 0.001) and the beta blockers/calcium channel blockers group ($17,612, 26.6% higher; P = 0.002). CONCLUSIONS: Adding ranolazine to the treatment regimen of patients with poorly controlled angina was associated with lower rates of revascularization and lower total costs of care than for comparable patients, differences both statistically and clinically relevant.