Estimating breast, stomach, and colorectal cancer incidence in Colombia through administrative database algorithms: A systematic review of literature and real-world data study.

Abstract

e18810 Background: Breast, stomach and colorectal cancers have high incidence in Colombia. Official cancer incidence registries depend upon sentinel site reports as there is no nationwide surveillance system. We aimed to identify administrative database algorithms for breast, stomach and colorectal cancer case selection and to compare their cancer incidence estimates to official registries. Methods: We conducted a systematic review to identify algorithms with high positive predictive values (VPP) for breast, stomach and colorectal cancer case identification in administrative databases. For each cancer we selected two algorithms: a sensitive algorithm, based on cancer-specific ICD-10 codes, and a specific algorithm, combining cancer-specific ICD-10 codes with at least one code for oncological procedures. We varied the number of months a cancer-specific ICD-10 code was registered within each algorithm to test for algorithm stability. We conducted a cohort study to estimate incident cancer cases for 2013 in four cancer sentinel cities in Colombia and one cancer reference center using both algorithms. We defined incident cases as cases lacking a cancer-specific ICD-10 code in the preceding two years and adjusted incident cases for type of regimen affiliation. Algorithms with results closest to official sources were selected as best performing algorithms. We used the contributive regimen Capitation Payment Unit administrative database of Colombia for 2011-2014 as source of information. Results: Breast cancer case-identification algorithms have a higher VPP reported in literature (83-100%) compared to colorectal (41.7-94%) and stomach cancer (35-59.7%) algorithms. The closest breast cancer incidence estimates to the official registries Infocancer and National Cancer Institute were yielded by the specific algorithm with ICD-10 codes persisting for four months (n= 672 vs 649 and 397 vs 212, respectively). The closest colorectal cancer cancer incidence estimates to official registries were yielded by the specific algorithm with ICD-10 codes persisting for three months (n= 219 vs 230 and 168 vs 139, respectively). The closest stomach cancer incidence estimates to official registries were yielded by the specific algorithm with ICD-10 codes persisting for one month (n= 122 vs 146 and 99 vs 153, respectively). Sensitive algorithms were less stable than specific algorithms across all three cancer types. Conclusions: Breast, stomach and colorectal incident cancer cases can be identified through administrative databases. VPP vary among types of algorithms and cancers. Specific algorithms provide better breast and colorectal incident cancer case-identification in Colombian administrative databases, compared to stomach cancer algorithms. This is a potential approach for estimating nationwide cancer incidence in Colombia.

Fragmentation of Care and Its Association With Survival and Costs for Patients With Breast Cancer in Colombia

“…This is an administrative claims database and does not have verified clinical information (pathology, stage at diagnosis, and results of diagnostic tests), therefore was necessary to build an electronic algorithm to identify cases, on the basis of diagnostic codes (ICD-10) and unique health procedure codes (UHPCs), as previously described. 21 In brief, patients who were registered for 4 or more months with ICD-10 codes associated with breast cancer (C500, C501, C502, C503, C504, C505, C506, C508, and C509) and at least one UHPC associated with oncologic procedures (chemotherapy, radiation therapy, and/or surgery) were identified as patients with a diagnosis of breast cancer (the complete list of ICD-10 and UHPC codes used in the electronic algorithm can be found in Appendix 1 ).…”

Net Costs of Breast Cancer in Colombia: A Cost-of- Illness Study Based on Administrative Claims Databases

“…To identify patients with BC affiliated with the contributory regime, this study used the electronic algorithm previously validated by Saldaña et al (24) Saldana et al compared the incidence estimates of breast, stomach, and colorectal cancer obtained by several electronic algorithms in the UPC database with the estimates published by a prospective, multicentric, cancer registry in Colombia known as Infocancer. The electronic algorithms that yielded the incidence estimates nearest to the ones published by Infocancer were selected as the recommended algorithms for research within the UPC database.…”

“…Using the specific algorithm described by Saldaña et al (24), this study identified 40,800 women with BC in the UPC database during 2019. Assuming a similar distribution of baseline risks with women with unavailable data, 46,148 women in the contributory regime suffered from BC and used at least one health service during 2019 (see Tables S5 and S6 in the additional file).…”

“…As mentioned above, to decrease the impact of including patients without the disease (i.e., false-positive cases), the study used the identification algorithm developed by Saldaña et al (24). According to these authors, BC identification algorithms have a high PPV compared to identification algorithms for other malignancies.…”

Association of healthcare fragmentation and the survival of patients with colorectal cancer in Colombia

“…Colombia, a middle-income country, has a mandatory insurance-based healthcare system that covers approximately 99% of Colombians (23). In this system, insurance companies serve a population of enrollees and administer the same bene t plan for all Colombians.…”