Identifying Psoriasis and Psoriatic Arthritis Patients in Retrospective Databases When Diagnosis Codes Are Not Available: A Validation Study Comparing Medication/Prescriber Visit–Based Algorithms with Diagnosis Codes

Dobson-Belaire, Wendy; Goodfield, Jason; Borrelli, Richard; Liu, Fei‐Fei; Khan, Zeba M.

doi:10.1016/j.jval.2017.06.012

Cited by 9 publications

(16 citation statements)

References 40 publications

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“…To mitigate misclassification bias, patients in the treated anxiety and/or depression group were required to have both a diagnosis and related medications to ensure patients truly had PsO and anxiety/depression. Such definitions are widely used in retrospective claims-based studies 23,24 . However, prevalence estimates from this study are still likely lower than the actual prevalence due to undiagnosed or untreated patients.…”

Section: Limitationsmentioning

confidence: 99%

Prevalence and economic burden of comorbid anxiety and depression among patients with moderate-to-severe psoriasis

Cai

Teeple

et al. 2019

Journal of Medical Economics

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Objective: To describe the prevalence and costs of anxiety and depression among moderate-to-severe psoriasis (PsO) patients in a commercially-insured US population. Methods: The IBM MarketScan Commercial database was used to select adults with moderate-tosevere PsO (!1 PsO diagnosis and !1 systemic or biologic medication) within each calendar year from 2014 to 2016. Adults with no diagnosis of PsO or similar disorders were randomly selected (2014-2016) and matched 1:1 to PsO patients to compare the prevalence of anxiety and depression each year. Moderate-to-severe PsO patients identified in 2014 with continuous enrollment through 2015 were stratified into those with treated anxiety and/or depression (!1 anxiety or depression diagnosis plus any anxiolytics, antidepressants, or antipsychotics within 30 days) vs those without anxiety/ depression, and then matched 1:1 to determine the incremental burden of treated anxiety/depression among PsO patients. All-cause and PsO-related healthcare costs were compared between the matched cohorts using generalized linear models. Results: In total, 69,644 matched PsO and non-PsO patients were identified in 2014, 61,478 in 2015, and 66,880 in 2016. The prevalence of anxiety/depression among PsO patients increased more than for matched controls, from 18.2% vs 12.2% in 2014 (p < 0.01) to 19.6% vs 13.1% in 2016 (p < 0.01). Prevalence of treated anxiety/depression followed the same trend, with increases from 14.5% vs 8.9% in 2014 (p < 0.01) to 15.9% vs 9.9% in 2016 (p < 0.01). For patients with moderate-to-severe PsO, unadjusted incremental all-cause healthcare costs associated with treated anxiety/depression were $8,077 (p < 0.01); 91% was due to utilization of medical services such as hospitalizations, ER visits, office visits, and other outpatient services (all p < 0.01). Conclusions: The prevalence of psychiatric disorders is higher among PsO patients than the general population, and the incremental burden of treated anxiety/depression is substantial. Further research is needed, but PsO treatments that improve psychiatric symptoms such as anxiety/depression may benefit patients and reduce their economic burden.

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Section: Limitationsmentioning

confidence: 99%

Prevalence and economic burden of comorbid anxiety and depression among patients with moderate-to-severe psoriasis

Cai

Teeple

et al. 2019

Journal of Medical Economics

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“…Furthermore, an algorithm that is solely based on medication use is not likely useful. In a study using PharmMetrics database, a commercial insurance claims database in the United States, when the PsA cohort was defined based on two or more PsA‐related prescription claims, the reported PPV was around 65% …”

Section: Discussionmentioning

confidence: 99%

“…However, in daily clinical practices, a detailed evaluation of PsA that satisfies CASPAR criteria is generally not performed nor documented. Second, some of the drugs used to treat PsA are also used in other rheumatic conditions which could potentially lead to misclassification . Third, our results may have limited generalizability as our study is based on Medicare claims linked to EHR data from two large healthcare provider networks in a single city.…”

Section: Discussionmentioning

confidence: 99%

Validation of claims‐based algorithms for psoriatic arthritis

Lee

Ford

Jin

et al. 2019

Pharmacoepidemiology and Drug

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Purpose: An increasing number of new medications are being developed and approved for psoriatic arthritis (PsA). To generate real-world evidence on comparative safety and effectiveness of these drugs, a claims-based algorithm that can accurately identify PsA is greatly needed.Methods: To identify patients with PsA, we developed seven claims-based algorithms based on a combination of diagnosis codes and medication dispensing using the claims data from Medicare parts A/B/D linked to electronic medical records (2012)(2013)(2014). Two physicians independently conducted a chart review using the treating physician's diagnosis of PsA as the gold standard. We calculated the positive predictive value (PPV) and 95% confidence intervals of each algorithm.Results: Of the total 2157 records identified by the seven algorithms, 45% of the records had relevant clinical data to determine the presence of PsA. The PPV of the algorithms ranged from 75.2% (algorithm 1: ≥2 diagnosis codes for PsA and ≥1 diagnosis code for psoriasis) to 88.6% (algorithm 7: ≥2 diagnosis codes for PsA with ≥1 code by rheumatologist and ≥1 dispensing for PsA medication). Having ≥2 diagnosis codes and ≥1 dispensing for PsA medications (algorithm 6) also had PPV of 82.4%.Conclusions: All seven claims-based algorithms demonstrated a moderately high PPV of 75% to 89% in identifying PsA. The use of ≥2 diagnosis codes plus ≥1 prescription claim for PsA appears to be a valid and efficient tool in identifying PsA patients in the claims data, while broader algorithms based on diagnoses without a prescription claim also have reasonably good PPVs. K E Y W O R D S claims database, Medicare, pharmacoepidemiology, psoriasis, psoriatic arthritis

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“…Patients ≥18 years of age with at least one diagnosis code for PsA (ICD-9-CM 696.0), or RA (ICD-9-CM 714.0–714.33), or AS (ICD-9-CM 720.0) prior to therapy initiation, and a prescription for a disease-modifying antirheumatic drug (DMARD) were included in the cohort. Studies have shown a higher PPV when diagnosis codes are combined with DMARD prescriptions to identify PsA, RA, and AS patients in health care utilization databases [ 30 – 35 ]. In a sensitivity analysis, we allowed patients to acquire the code for IA at any point during follow up.…”

Section: Methodsmentioning

confidence: 99%

Impact of tumor necrosis factor inhibitors and methotrexate on diabetes mellitus among patients with inflammatory arthritis

et al. 2020

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Background To determine whether initiation of a tumor necrosis factor inhibitor (TNFi) or methotrexate improves hemoglobin A1c in patients with psoriatic arthritis (PsA), rheumatoid arthritis (RA), or ankylosing spondylitis (AS) who also have diabetes mellitus (DM). Methods A retrospective cohort study was conducted in Optum’s de-identified Clinformatics® Data Mart Database, an administrative claims database, using data from 2000 to 2014. Patients with PsA, RA, or AS, with DM (defined by ICD-9-CM codes) and/or HbA1c ≥7%, who newly initiated either a TNFi, MTX, or metformin (positive control) were identified. The change in HbA1c after drug initiation was calculated. Statistical differences in the change in HbA1c between drugs were assessed using the Wilcoxon rank sum test and linear regression models adjusting for potential confounders. Results Among 10,389 drug initiations in 9541 patients with PsA, RA, or AS, and available HbA1c values, HbA1c was ≥7 at baseline in 254 (35%) TNFi initiations, 361(37%) MTX initiations, and 2144 (50%) metformin initiations. Median HbA1c change was − 0.35 (IQR -1.10, 0.30) after TNFi initiation, − 0.40 (IQR -1.20, 0.30) after MTX initiation, and − 0.80 (IQR -1.60, − 0.10) after metformin initiation. In adjusted analyses, TNFi initiators had less of a decrease in HbA1c compared to MTX initiators (β 0.22, 95% CI: 0.004, 0.43), p = 0.046. Metformin initiators had a significantly greater decrease in HbA1c than MTX, β − 0.38 (95% CI: − 0.52, − 0.23), p < 0.001. Glucocorticoid use was not accounted for in the models. Conclusion HbA1c decreased with TNFi initiation or MTX initiation. Reductions in HbA1c after initiation of a TNFi or MTX are about half ( ~ 0.4 units) the decrease observed after initiation of metformin.

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Identifying Psoriasis and Psoriatic Arthritis Patients in Retrospective Databases When Diagnosis Codes Are Not Available: A Validation Study Comparing Medication/Prescriber Visit–Based Algorithms with Diagnosis Codes

Abstract: We have developed an MC/PV-based algorithm to identify PsO patients with a high degree of accuracy, but accuracy for PsO-AC requires further investigation. Such methods allow researchers to conduct retrospective studies in databases in which diagnosis codes are absent.

Cited by 9 publications

References 40 publications

Prevalence and economic burden of comorbid anxiety and depression among patients with moderate-to-severe psoriasis

Prevalence and economic burden of comorbid anxiety and depression among patients with moderate-to-severe psoriasis

Validation of claims‐based algorithms for psoriatic arthritis

Impact of tumor necrosis factor inhibitors and methotrexate on diabetes mellitus among patients with inflammatory arthritis

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