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Administrative data algorithms to identify diagnosis and treatment-related measures in patients with multiple myeloma
A validation study
Parikh, R., Clancy, Z., Candrilli, S., & Parikh, K. (2018). Administrative data algorithms to identify diagnosis and treatment-related measures in patients with multiple myeloma: A validation study. Journal of Managed Care and Specialty Pharmacy, 24(4-a Suppl), S29. Article C21. https://doi.org/10.18553/jmcp.2018.24.4-a.s1
BACKGROUND: Analyses of secondary data (e.g., insurance claims) to
generate real-world evidence often entail use of algorithms to identify,
define, and study key measures (e.g., diagnosis [dx] date; receipt of
therapy).
OBJECTIVE: To systematically assess the validity of claims data-based
algorithms used to identify multiple myeloma (MM) dx and treatmentrelated
measures.
METHODS: A retrospective, observational study was conducted using
claims data from Geisinger Health (GH), an integrated health care
delivery system in Pennsylvania. In a cohort of patients with MM from
January 2004-November 2016, algorithms were used to identify and
define measures related to dx and ensuing therapy. Measures from
claims data were adjudicated against a medical record review (MRR)
to evaluate the validity of the claims-based algorithms. Validity of
claims-based study measures were evaluated by assessing positive predictive
values (PPV) and proportions. PPV was calculated as the number
of true-positives divided by the sum of true- and false-positives.
RESULTS: Of 352 patients with 2 MM dx claims 30 days apart, MRR
was conducted for 177 patients who met other selection criteria (e.g.,
12-month pre-index period without MM dx). Most (68.9%) were 65
years old and 54.8% were male. Of the patients reviewed, 131 had
a confirmed MM dx, per the MRR, with a PPV of 74.0% (95% CI:
67.680.5%). Among these, 84.7% (95% CI: 78.6-90.9%) of patients
had an initial MM dx date from claims within 30 days of the initial
MM dx date ascertained from the MRR. From the MRR, 89.3% of
patients were confirmed to receive first-line (1L) therapy versus 82.4%
of patients identified using the claims-based algorithms. The resulting
PPV was 94.4% (95% CI: 90.1-98.8%). Based on the claims-based algorithms,
56.5%, 22.2%, and 21.3% of patients received doublet, steroid
only, and triplet regimens, respectively. The MRR showed that 63.3%,
26.5%, and 6.8% received doublet, triplet, and steroid only regimens,
respectively. The proportion having the same 1L regimens identified
from claims and MRR was 66.7% (95% CI: 57.8-75.6%); those with
the same bortezomib- or lenalidomide-based 1L regimens was 77.8%
(95% CI: 68.2-87.4%). Among patients receiving 1L therapy, 45.4%
and 48.7% had evidence of progression from claims and MRR, respectively
(resulting PPV: 63.3% [95% CI: 49.8-76.8%]).
CONCLUSIONS: Using GH data, the claims-based algorithms had
a PPV/proportion of >70% for identifying true MM dx, receipt of
1L therapy, and 1L bortezomib- or lenalidomide-based regimens.
Previous validation studies have reported similar PPVs.