Using health insurance reimbursement data to identify incident cancer cases

Chao, Shi; Liu, Mengfei; Liu, Zhen; Guo, Chuanhai; Li, Fenglei; Xu, Ruiping; Liu, Fangfang; Liu, Ying; Li, Jingjing; Cai, Hong; He, Zhonghu; Ke, Yang

doi:10.1016/j.jclinepi.2019.06.009

Cited by 23 publications

(23 citation statements)

References 26 publications

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“…First, the MIS-CASS is a real population level cancer surveillance system with >95% coverage on a national scale, which is distinct from health insurance systems in some western countries such as Medicare and the Ontario Health Insurance Plan [32,33]. Second, the original claims data of MIS-CASS is of high quality [17], as the diagnostic information is entered by professionals in qualified medical institutions and verified by officials from medical insurance managing departments. Third, the proportion of cancer cases missed by the MIS-CASS is low, based on our two previous individual level comparative evaluation studies [16À18].…”

Section: Discussionmentioning

confidence: 99%

“…The quality of claims data per se determines the accuracy and completeness of collecting cancer cases, and two of our preceding studies have addressed this issue. In one study we compared active follow-up (door-to-door interviews) with passive linkage with NCMS claims data for identification of incident cancer cases in a large-scale randomized controlled trial involving 33,948 subjects from 2012 to 2017, and found that the overall sensitivity of passive linkage with NCMS claims data was significantly higher than that of active followup (95¢6% vs 54¢9%, p < 0¢001) [17]. In another study, we further verified claims-based diagnoses with corresponding electronic medical records at an individual level in the general population in Hua County in 2017.…”

Section: Introductionmentioning

confidence: 99%

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Estimating cancer incidence based on claims data from medical insurance systems in two areas lacking cancer registries in China

Tian

Yang

Hu³

et al. 2020

EClinicalMedicine

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Background: We aimed to establish a Medical-Insurance-System-based Cancer Surveillance System (MIS-CASS) in China and evaluate the completeness and timeliness of this system through reporting cancer incidence rates using claims data in two regions in northern and southern China. Methods: We extracted claims data from medical insurance systems in Hua County of Henan Province, and Shantou City in Guangdong Province in China from Jan 1, 2012 to Jun 30, 2019. These two regions have been considered to be high risk regions for oesophageal cancer. We developed a rigorous procedure to establish the MIS-CASS, which includes data extraction, cleaning, processing, case ascertainment, privacy protection, etc. Text-based diagnosis in conjunction with ICD-10 codes were used to determine cancer diagnosis. Findings: In 2018, the overall age-standardised (Segi population) incidence rates (ASR World) of cancer in Hua County and Shantou City were 167¢39/100,000 and 159¢78/100,000 respectively. In both of these areas, lung cancer and breast cancer were the most common cancers in males and females respectively. Hua County is a high-risk region for oesophageal cancer (ASR World: 25¢95/100,000), whereas Shantou City is not a highrisk region for oesophageal cancer (ASR World: 11¢43/100,000). However, Nanao island had the highest incidence of oesophageal cancer among all districts and counties in Shantou (ASR World: 36¢39/100,000). The age-standardised male-to-female ratio for oesophageal cancer was lower in Hua County than in Shantou (1¢69 vs. 4¢02). A six-month lag time was needed to report these cancer incidences for the MIS-CASS. Interpretation: MIS-CASS efficiently reflects cancer burden in real-time, and has the potential to provide insight for improvement of cancer surveillance in China.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Estimating cancer incidence based on claims data from medical insurance systems in two areas lacking cancer registries in China

Tian

Yang

Hu³

et al. 2020

EClinicalMedicine

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“…For patients insured by NCMS, diagnosis-related information for each inpatient visit is entered and stored in the medical insurance system once the reimbursement process is completed, which makes it theoretically feasible to identify hospitalized cancer patients. A recent study used NCMS claims data as one means of following up subjects in a screening trial cohort for newly diagnosed cancer cases, supporting the potential of NCMS-claims-based cancer incidence surveillance (17). However, before general application of this method, evaluating the accuracy of cancer diagnoses in NCMS claims at the individual level based on real-world cancer patients’ data in a larger population is needed.…”

Section: Introductionmentioning

confidence: 90%

Identification of cancer patients using claims data from health insurance systems: A real-world comparative study

Tian

et al. 2019

Chinese Journal of Cancer Research

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ObjectiveTo evaluate the accuracy of identifying cancer patients by use of medical claims data in a health insurance system in China, and provide the basis for establishing the claims-based cancer surveillance system in China.MethodsWe chose Hua County, Henan Province as the study site, and randomly selected 300 and 1,200 qualified inpatient electronic medical records (EMRs) as well as the New Rural Cooperative Medical Scheme (NCMS) claims records for cancer patients in Hua County People’s Hospital (HCPH) and Anyang Cancer Hospital (ACH) in 2017. Diagnostic information for NCMS claims was evaluated on an individual level, and sensitivity and positive predictive value (PPV) were calculated taking the EMRs as the gold standard.ResultsThe sensitivity of NCMS was 95.2% (93.8%−96.3%) and 92.0% (88.3%−94.8%) in ACH and HCPH, respectively. The PPV of the NCMS was 97.8% (96.7%−98.5%) in ACH and 89.0% (84.9%−92.3%) in HCPH. Overall, the weighted and combined sensitivity and PPV of NCMS in Hua County was 93.1% and 92.1%, respectively. Significantly higher sensitivity and PPV in identifying patients with common cancers than non-common cancers were detected in HCPH and ACH separately (P<0.01).ConclusionsIdentification of cancer patients by use of the NCMS is accurate on individual level, and it is therefore feasible to conduct claims-based cancer surveillance in areas not covered by cancer registries in China.

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“…First, information regarding the clinical treatment regimen of the participants was collected with linkage to claims data from the New Rural Cooperative Medical Scheme (NCMS), which is a government-run health insurance program in rural China with coverage of nearly 100% in the study area that had previously proved to be a reliable data source regarding cancer diagnosis and treatment. [13] , [14] , [15] Detailed claims records from the NCMS for all participants from January 2012 to September 2017 were carefully reviewed to confirm whether they had received cancer-related therapy, which included endoscopic therapy, radical surgery, radiotherapy, and chemotherapy.…”

Section: Methodsmentioning

confidence: 99%

Health-seeking behavior and barriers to treatment of patients with upper gastrointestinal cancer detected by screening in rural China: real-world evidence from the ESECC trial

Wang

Liu

Guo

et al. 2021

The Lancet Regional Health - Western Pacific

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Background: To fully realize efficacy in cancer screening, timely and appropriate treatment for participants with malignant lesions is critical. However, the health-seeking behavior of patients with upper gastrointestinal (G.I.) cancer identified in population-level screening programs in China is unknown.Methods: A community-based real-world investigation was conducted with 136 upper G.I. cancer patients detected in a large screening cohort in an area of high-risk for upper G.I. cancer in China. Using local medical claims data and semi-structured face-to-face interview, we collected information regarding the clinical treatment regimen and factors which result in the lack of timely and appropriate treatment. Findings:The treatment records for 133 upper G.I. cancer patients were acquired. Among these, 48 (36 • 09%) patients did not receive treatment within three months of initial diagnosis, and treatment of early-stage cancer was more likely to be delayed. Sixteen patients did not seek further diagnostic testing due to their low health-awareness and socio-economic status. Another 20 participants proactively sought further diagnostic evaluation in health care facilities but were prevented from receiving further treatment due to low sensitivity of given diagnostic test(s), failure to recognize the significance of screening results, and/or lack of basic knowledge of diagnosis and treatment for early cancer on the part of clinicians. The treatment regimen offered to patients depended largely on the level of health care facilities they visited, and non-medical factors were the main reasons for choice of health care facilities.Interpretation: A coordinated, system-based management strategy is urgently needed to support the design of upper G.I. cancer screening programs in rural populations in China.

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Using health insurance reimbursement data to identify incident cancer cases

Cited by 23 publications

References 26 publications

Estimating cancer incidence based on claims data from medical insurance systems in two areas lacking cancer registries in China

Estimating cancer incidence based on claims data from medical insurance systems in two areas lacking cancer registries in China

Identification of cancer patients using claims data from health insurance systems: A real-world comparative study

Health-seeking behavior and barriers to treatment of patients with upper gastrointestinal cancer detected by screening in rural China: real-world evidence from the ESECC trial

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