Development and Validation of Algorithms to Identify Pulmonary Arterial Hypertension in Administrative Data

Gillmeyer, Kari R.; Núñez, Eduardo; Rinne, Seppo T.; Qian, Shirley; Klings, Elizabeth S.; Wiener, Renda Soylemez

doi:10.1016/j.chest.2020.12.010

Cited by 13 publications

(34 citation statements)

References 23 publications

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“…Some of the ICD‐9‐CM and ICD‐10‐CM diagnosis codes used to identify members with PAH were for PH and not PAH specifically, so it is possible we inadvertently captured members with PH Groups 2–5 in our definition. We increased specificity of identifying members with PAH by also requiring medications for PAH and an RHC as inclusion criteria, 34 , 35 , 36 but riociguat is used to treat both PH group 1 (i.e., PAH) and PH group 4 disease. Second, important member demographics, clinical characteristics, and data on health‐related quality of life are not available in medical and pharmacy claims.…”

Section: Discussionmentioning

confidence: 99%

Real‐world treatment patterns, healthcare resource utilization, and cost among adults with pulmonary arterial hypertension in the United States

et al. 2022

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Treatment for pulmonary arterial hypertension (PAH) has evolved over the past decade, including approval of new medications and growing evidence to support earlier use of combination therapy. Despite these changes, few studies have assessed real-world treatment patterns, healthcare resource utilization (HCRU), and costs among people with PAH using recent data. We conducted a retrospective cohort study using administrative claims from the HealthCore Integrated Research Data-base®. Adult members with claims for a PAH diagnosis, right heart catheterization, and who initiated PAH treatment (index date) between October 1, 2015 and November 30, 2020 were identified. Members had to be continuously enrolled in the health plan for 6 months before the index date (baseline) and ≥30 days after. Treatment patterns, HCRU, and costs were described. A total of 843 members with PAH (mean age 62.3 years, 64.2% female) were included. Only 21.0% of members received combination therapy as their first-line treatment, while most members (54.6%) received combination therapy as second-line treatment. All-cause HCRU remained high after treatment initiation with 58.0% of members having ≥1 hospitalization and 41.3% with ≥1 emergency room visit.

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Section: Discussionmentioning

confidence: 99%

Real‐world treatment patterns, healthcare resource utilization, and cost among adults with pulmonary arterial hypertension in the United States

et al. 2022

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“…To ascertain the true diagnosis of patients with PAH, not only ICD-9/10-CM codes of PH-or PAH-associated diseases and NHI claim codes of PAH-specific medication were used, but also the specialty of the physician or enrollment of catastrophic illness registry were identified. The identification algorithm was validated by a previous study with a positive predictive value of 32.5-78.0% (Sprecher et al, 2020;Gillmeyer et al, 2021). Additionally, physicians need prior authorization to prescribe PAH-targeted medication, which means that patients' medical charts would be reviewed before using most PAH-specific medications, except for sildenafil.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Adherence and treatment patterns of disease-specific drugs among patients with pulmonary arterial hypertension: A nationwide, new-user cohort study

2023

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Background: Pulmonary arterial hypertension (PAH) is an incurable pulmonary disease that might result in right heart failure and death. Treatment guidelines recommend upfront or sequential combination therapy for patients with PAH. Recently, several PAH-targeted medications have been approved in Taiwan. This study aimed to investigate treatment patterns and medication adherence in real-world settings.Method: This was a new-user design study on patients treated with PAH-specific medication between 1 January 2014, and 31 December 2019. Data were extracted from the National Health Insurance Research Database. Medication adherence was evaluated by the proportion of days covered (PDC). Adherence was defined as PDC ≥ .8. Statistical analyses were performed to compare the study outcomes. Logistic regression analysis was performed to identify the association between baseline characteristics and adherence. P < .05 indicated statistical significance.Results: A total of 1,900 patients with PAH were identified, and 75.3% of them were females. The mean (standard deviation (SD)) age was 57.2 (17.5) years. Only 23 (1.2%) patients began the initial combination therapy. A total of 148 (7.8%) patients switched their initial treatment to another treatment, and 159 (8.4%) patients had sequential combination therapy. The most common combination therapy was endothelin receptor antagonist (ERA) plus phosphodiesterase-5 inhibitor (PDE5i), mostly macitentan plus sildenafil, for initial or sequential combination. The mean (SD) PDC was .71 (.33), and 1,117 (58.8%) patients were adherent. A significant difference in mean PDC was observed between initial ERA users and PDE5i users (p < .0001). No factor was significantly associated with medication adherence.Conclusion: Patients with PAH mostly initiated sildenafil as monotherapy, and macitentan was added as a sequential combination therapy. The initial ERA and combination groups showed higher medication adherence. Further investigations are needed to identify other factors associated with adherence.

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“…There are limitations of the previous cohorts as they are predominately outpatient cohorts with a mix of PH clinic patients and real‐world populations. 4 , 5 These studies also included PH therapies and RHC in their validation algorithms, information that is often sparse in population level administrative data limiting generalizability. Our study captures in‐patient administrative data.…”

Section: Discussionmentioning

confidence: 99%

“…This may explain better operational characteristics for identification of PH patients using our algorithm than was observed in prior studies that used more complex algorithms, which included PH therapies and procedures such as RHC. 4 , 5 Our method is pragmatic in that it uses readily available ICD codes. This is especially relevant for countries such as Canada, where ICD based coding is only captured in hospital based settings, as there are no specific Ontario Health Insurance Plan (OHIP) physician billing codes available for PH, which makes population‐based, outpatient studies challenging for PH.…”

Section: Discussionmentioning

confidence: 99%

“…A large proportion of patients were from the VA cohort (12,000 vs. 500 from a PH referral center) and hence was predominantly male, limiting generalizability as PH is significantly more prevalent in females. 5 Both these studies use complex algorithms incorporating variables such as right heart catheterization, that is often sparse and not pragmatic in population level studies.…”

Section: Introductionmentioning

confidence: 99%

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Using health administrative data to identify patients with pulmonary hypertension: A single center, proof of concept validation study in Ontario, Canada

et al. 2022

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Real‐world identification of pulmonary hypertension (PH) is largely based on the use of administrative databases identified by ICD codes. This approach has not been validated. The aim of this study was to validate a diagnosis of PH and its comorbidities using ICD 9/10 codes. Health records from Kingston Health Sciences Centre (2010 to 2012) were abstracted to identify a diagnosis of PH. Cohort 1 patients (n = 300) were selected because they had attended a cardiology or respirology clinic without knowledge of PH status. Cohort 2 patients (n = 200) were patients with a diagnosis of PH, identified using International Classification of Diseases (ICD) codes at the time of hospitalizations (CIHI‐DAD) or emergency department (ED) visits (CIHI‐NACRS). These cohorts were combined and reviewed to validate the diagnosis of PH. These data were securely transferred to the Institute of Clinical Evaluative Sciences (ICES). The diagnosis of PH from chart abstraction was used as the gold standard. The classification of PH into WHO groups, based on chart abstraction, was also compared to classification based on ICD code‐defined comorbidities. Cohort 1 and Cohort 2 were merged to yield 449 unique patients in the combined cohort. In the combined cohort, 248 of 449 (55.2%) had a diagnosis of PH by ICD code criteria. The mean age of this PH group was 70 years, and the majority were females (65.5%). One hospitalization or ED visit resulting in a diagnostic code for PH had a sensitivity of 73% and a specificity of 99% for a confirmed PH diagnosis on chart abstraction. When WHO classification by chart abstraction and ICD codes for comorbidities were compared, there was 87% agreement. Identification of PH and its comorbidities using ICD codes is a valid approach, and this single‐center study supports its application to identify PH.

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Development and Validation of Algorithms to Identify Pulmonary Arterial Hypertension in Administrative Data

Cited by 13 publications

References 23 publications

Real‐world treatment patterns, healthcare resource utilization, and cost among adults with pulmonary arterial hypertension in the United States

Real‐world treatment patterns, healthcare resource utilization, and cost among adults with pulmonary arterial hypertension in the United States

Adherence and treatment patterns of disease-specific drugs among patients with pulmonary arterial hypertension: A nationwide, new-user cohort study

Using health administrative data to identify patients with pulmonary hypertension: A single center, proof of concept validation study in Ontario, Canada

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