Identification of Patients With Nonmelanoma Skin Cancer Using Health Maintenance Organization Claims Data

Abstract

Cancer registries usually exclude nonmelanoma skin cancers (NMSC), despite the large population affected. Health maintenance organization (HMO) and health system administrative databases could be used as sampling frames for ascertaining NMSC. NMSC patients diagnosed between January 1, 1988, and December 31, 2007, from such defined US populations were identified by using 3 algorithms: NMSC International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes, NMSC treatment Current Procedural Terminology (CPT) codes, or both codes. A subset of charts was reviewed to verify NMSC diagnosis, including all records from HMO-enrollee members in 2007. Positive predictive values for NMSC ascertainment were calculated. Analyses of data from 1988-2007 ascertained 11,742 NMSC patients. A random sample of 965 cases was selected for chart review, and NMSCs were validated in 47.0% of ICD-9-CM-identified patients, 73.4% of CPT-identified patients, and 94.9% identified with both codes. All charts from HMO-health plan enrollees in 2007 were reviewed (n = 1,116). Cases of NMSC were confirmed in 96.5% of ICD-9-CM-identified patients, 98.3% of CPT-identified patients, and 98.7% identified with both codes. HMO administrative data can be used to ascertain NMSC with high positive predictive values with either ICD-9-CM or CPT code, but both codes may be necessary among non-HMO patient populations.

Vitamin D and Nonmelanoma Skin Cancer in a Health Maintenance Organization Cohort

“…A validated claims-based NMSC ascertainment algorithm and HMO electronic medical records permitted identification of incident skin cancer by histologic subtype and allowed us to ascertain chronically UVexposed and lesser-exposed anatomical tumor locations. 29 Use of electronic medical records also eliminated recall bias, which may have been present in a prior investigation in which NMSC was self-reported. 23 Furthermore, our cohort was followed up for almost 10 years and excluded those with human immunodeficiency virus or solid organ transplant recipients.…”

“…This NMSC claims-based ascertainment algorithm has been previously validated and described. 29 The NMSC incident cases were further validated. A trained abstractor reviewed the electronic pathology records to determine histologic subtype, which included BCC, SCC, and SCC in situ (Bowen disease), and anatomical location.…”

Incidence rates of malignancies and hospitalized infectious events in patients with psoriasis with or without treatment and a general population in the U.S.A.: 2005–09

“…[9][10][11][12][13][14][15][16] Among patients with psoriasis using systemic therapies, there is as much as a 50% greater risk for all malignancies when excluding NMSC and lymphoproliferative malignancies, a 4-fold increased relative risk of NMSC, and an 8-times greater risk of lymphoproliferative malignancies. [10][11][12][13][14][15][16] Among patients with autoimmune inflammatory conditions such as psoriasis, the incidence of serious infectious events (SIEs) is increased among those using antipsoriatic treatments. [17][18][19][20] Some studies suggest lower rates among patients < 65 years old compared with patients aged 65 and older.…”

Physician Specialty Cost Differences of Treating Nonmelanoma Skin Cancer

“…Although the positive predictive value for the identification of NMSC cases using an algorithm of both International Classification of Diseases, Ninth Revision, Clinical Modification and CPT codes was 94.9%, 43 all episodes in our sample contained a procedure for the treatment of benign lesions in the preindex date period, which is concurrent with the reported rate of 1.6 number needed to treat to correctly discriminate NMSC from benign lesions by dermatologists. 44 We should, however, assume that mistaking malignant tumors for benign tumors should be included as part of the clinical path to diagnosing NMSC.…”