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Yuan S, Wu Y. Effectiveness and cost-effectiveness of six GLP-1RAs for treatment of Chinese type 2 diabetes mellitus patients that inadequately controlled on metformin: a micro-simulation model. Front Public Health 2023; 11:1201818. [PMID: 37744474 PMCID: PMC10513082 DOI: 10.3389/fpubh.2023.1201818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Objective To systematically estimate and compare the effectiveness and cost-effectiveness of the glucagon-like peptide-1 receptor agonists (GLP-1RAs) approved in China and to quantify the relationship between the burden of diabetic comorbidities and glycosylated hemoglobin (HbA1c) or body mass index (BMI). Methods To estimate the costs (US dollars, USD) and quality-adjusted life years (QALY) for six GLP-1RAs (exenatide, loxenatide, lixisenatide, dulaglutide, semaglutide, and liraglutide) combined with metformin in the treatment of patients with type 2 diabetes mellitus (T2DM) which is inadequately controlled on metformin from the Chinese healthcare system perspective, a discrete event microsimulation cost-effectiveness model based on the Chinese Hong Kong Integrated Modeling and Evaluation (CHIME) simulation model was developed. A cohort of 30,000 Chinese patients was established, and one-way sensitivity analysis and probabilistic sensitivity analysis (PSA) with 50,000 iterations were conducted considering parameter uncertainty. Scenario analysis was conducted considering the impacts of research time limits. A network meta-analysis was conducted to compare the effects of six GLP-1RAs on HbA1c, BMI, systolic blood pressure, and diastolic blood pressure. The incremental net monetary benefit (INMB) between therapies was used to evaluate the cost-effectiveness. China's per capita GDP in 2021 was used as the willingness-to-pay threshold. A generalized linear model was used to quantify the relationship between the burden of diabetic comorbidities and HbA1c or BMI. Results During a lifetime, the cost for a patient ranged from USD 42,092 with loxenatide to USD 47,026 with liraglutide, while the QALY gained ranged from 12.50 with dulaglutide to 12.65 with loxenatide. Compared to exenatide, the INMB of each drug from highest to lowest were: loxenatide (USD 1,124), dulaglutide (USD -1,418), lixisenatide (USD -1,713), semaglutide (USD -4,298), and liraglutide (USD -4,672). Loxenatide was better than the other GLP-1RAs in the base-case analysis. Sensitivity and scenario analysis results were consistent with the base-case analysis. Overall, the price of GLP-1RAs most affected the results. Medications with effective control of HbA1c or BMI were associated with a significantly smaller disease burden (p < 0.05). Conclusion Loxenatide combined with metformin was identified as the most economical choice, while the long-term health benefits of patients taking the six GLP-1RAs are approximate.
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Affiliation(s)
| | - Yingyu Wu
- Department of Pharmacoeconomics, School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, Jiangsu, China
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Li Y, Yu D, Guo L, Mu Y, Wan H, Wang J, Xu B, Wang G, Jiang C, Liang L, Zhang J, Liu J, Zhang M, Cui N. Efficacy and safety of basal-first titration order in individuals with type 2 diabetes receiving short-term intensive insulin therapy: An exploratory analysis of BEYOND V. Diabetes Obes Metab 2023; 25:1221-1228. [PMID: 36594649 DOI: 10.1111/dom.14970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023]
Abstract
AIMS To present the results of an exploratory analysis of the BEYOND V study in which Chinese individuals with uncontrolled type 2 diabetes (T2D) received short-term intensive insulin therapy (SIIT) during study run-in (prior to randomization) using a basal-first insulin titration method. MATERIALS AND METHODS This was exclusively an exploratory analysis of the 7- to 10-day run-in period of BEYOND V. Participants were hospitalized and had oral therapies withdrawn (except metformin). They received SIIT with once-daily insulin glargine and three-times-daily premeal insulin glulisine, titrated daily from a total starting dose of 0.4 to 0.5 units/kg/d, first adjusting insulin glargine to achieve fasting blood glucose (FBG) of 4.4 to 6.1 mmol/L (79 to 119 mg/dL), then insulin glulisine to achieve pre-meal blood glucose of 4.4 to 6.1 mmol/L. Key outcomes were the proportions of participants achieving FBG and 2-hour postprandial blood glucose (PBG) targets. RESULTS Overall, 397 entered the run-in (mean 54.2 years, 235 males [59.2%]). At the end of SIIT, 374/396 participants (94.4%) had both FBG <7.0 mmol/L (<126 mg/dL) and 2-hour PBG <10 mmol/L (<180 mg/dL) and 282/396 (71.2%) had both FBG <6.1 mmol/L (<100 mg/dL) and 2-hour PBG <10 mmol/L. The mean first time taken to achieve FBG <7 mmol/L, 2-hour PBG <10 mmol/L, and both, was 4.35, 3.88, and 5.04 days, respectively. Hypoglycaemia occurred in 99 participants (24.9%). There was no severe hypoglycaemia. CONCLUSIONS Titrating basal insulin first is an effective and safe method of SIIT in individuals with T2D, rapidly achieving target glucose levels with a relatively low rate of hypoglycaemia.
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Affiliation(s)
- Yijun Li
- The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Dongni Yu
- Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Lixin Guo
- Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Yiming Mu
- The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | | | - Junfen Wang
- Second Hospital of Shijiazhuang, Shijiazhuang, China
| | - Binhua Xu
- Harbin the First Hospital, Harbin, China
| | - Guoping Wang
- Second Affiliated Hospital of Baotou Medical College, Baotou, China
| | | | - Li Liang
- People's Hospital of Liaoning Province, Shenyang, China
| | - Jiewen Zhang
- Medical Department, Sanofi Investment Co, Ltd., Shanghai, China
| | - Jingcheng Liu
- Medical Department, Sanofi Investment Co, Ltd., Shanghai, China
| | - Minlu Zhang
- Medical Department, Sanofi Investment Co, Ltd., Shanghai, China
| | - Nan Cui
- Medical Department, Sanofi Investment Co, Ltd., Shanghai, China
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Wu Y, Li R, Zhang Y, Long T, Zhang Q, Li M. Prediction Models for Prognosis of Hypoglycemia in Patients with Diabetes: A Systematic Review and Meta-Analysis. Biol Res Nurs 2023; 25:41-50. [PMID: 35839096 DOI: 10.1177/10998004221115856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To systematically summarize the reported prediction models for hypoglycemia in patients with diabetes, compare their performance, and evaluate their applicability in clinical practice. METHODS We selected studies according to the PRISMA, appraised studies according to the Prediction model Risk of Bias Assessment Tool (PROBAST), and extracted and synthesized the data according to the CHARMS. The databases of PubMed, Web of Science, Embase, and Cochrane Library were searched from inception to 31 October 2021 using a systematic review approach to capture all eligible studies developing and/or validating a prognostic prediction model for hypoglycemia in patients with diabetes. The risk bias and clinical applicability were assessed using the PROBAST. The meta-analysis of the performance of the prediction models were also conducted. The protocol of this study was recorded in PROSPERO (CRD42022309852). RESULTS Sixteen studies with 22 models met the eligible criteria. The predictors with the high frequency of occurrence among all models were age, HbA1c, history of hypoglycemia, and insulin use. A meta-analysis of C-statistic was performed for 21 prediction models, and the summary C-statistic and its 95% confidence interval and prediction interval were 0.7699 (0.7299-0.8098), 0.7699 (0.5862-0.9536), respectively. Heterogeneity exists between different hypoglycemia prediction models (τ2 was 0.00734≠0). CONCLUSIONS The existing predictive models are not recommended for widespread clinical use. A high-quality hypoglycemia screening tool should be developed in future studies.
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Affiliation(s)
- Yi Wu
- Peking University Health Science Center, Beijing, China.,School of Nursing, 540405Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Ruxue Li
- Peking University Health Science Center, Beijing, China.,School of Nursing, 540405Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Yating Zhang
- Peking University Health Science Center, Beijing, China.,School of Nursing, 540405Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Tianxue Long
- Peking University Health Science Center, Beijing, China.,School of Nursing, 540405Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Qi Zhang
- Peking University Health Science Center, Beijing, China.,School of Nursing, 540405Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Mingzi Li
- Peking University Health Science Center, Beijing, China.,School of Nursing, 540405Peking University, Beijing, China.,Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
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Pan Q, Li Y, Wan H, Wang J, Xu B, Wang G, Jiang C, Liang L, Feng W, Liu J, Wang T, Zhang X, Cui N, Mu Y, Guo L. Efficacy and safety of a basal insulin + 2-3 oral antihyperglycaemic drugs regimen versus a twice-daily premixed insulin + metformin regimen after short-term intensive insulin therapy in individuals with type 2 diabetes: The multicentre, open-label, randomized controlled BEYOND-V trial. Diabetes Obes Metab 2022; 24:1957-1966. [PMID: 35642463 PMCID: PMC9543477 DOI: 10.1111/dom.14780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/18/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022]
Abstract
AIM To compare the efficacy and safety of basal insulin glargine 100 units/ml (Gla) + 2-3 oral antihyperglycaemic drugs (OADs) with twice-daily premixed insulin aspart 70/30 (Asp30) + metformin (MET) after short-term intensive insulin therapy in adults with type 2 diabetes in China. MATERIALS AND METHODS This open-label trial enrolled insulin-naïve adults with type 2 diabetes and an HbA1c of 7.5%-11.0% (58-97 mmol/mol) despite treatment with 2-3 OADs. All participants stopped previous OADs except MET, then received short-term intensive insulin therapy during the run-in period, when those with a fasting plasma glucose of less than 7.0 mmol/L and 2-hour postprandial glucose of less than 10.0 mmol/L were randomized to Gla + MET + a dipeptidyl peptidase-4 inhibitor or twice-daily Asp30 + MET. If HbA1c was more than 7.0% (>53 mmol/mol) at week 12, participants in the Gla group were added repaglinide or acarbose, at the physician's discretion, and participants in the Asp30 group continued to titrate insulin dose. The change in HbA1c from baseline to week 24 was assessed in the per protocol (PP) population (primary endpoint). RESULTS There were 384 enrollees (192 each to Gla and Asp30); 367 were included in the PP analysis. The threshold for non-inferiority of Gla + OADs versus Asp30 + MET was met, with a least squares mean change from baseline in HbA1c of -1.72% and -1.70% (-42.2 and -42.1 mmol/mol), respectively (estimated difference -0.01%; 95% CI -0.20%, 0.17% [-0.1 mmol/mol; 95% CI -2.2, 1.9]). Achievement of HbA1c less than 7.0% (<53 mmol/mol) was comparable between the groups (60% vs. 57%). The proportion of participants with any (24% vs. 38%; P = .003), symptomatic (19% vs. 31%; P = .007) or confirmed hypoglycaemia (18% vs. 33%; P < .001) was lower in the Gla + OADs group. CONCLUSIONS Compared with Asp30 + MET, Gla + 2-3 OADs showed similar efficacy but a lower hypoglycaemia risk in Chinese individuals with type 2 diabetes who had undergone short-term intensive insulin therapy.
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Affiliation(s)
- Qi Pan
- Department of Endocrinology, Beijing HospitalNational Center of GerontologyBeijingChina
| | - Yijun Li
- Department of EndocrinologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Hailong Wan
- Department of EndocrinologyPanjin Central HospitalPanjinChina
| | - Junfen Wang
- Department of EndocrinologySecond Hospital of ShijiazhuangShijiazhuangChina
| | - Binhua Xu
- Department of EndocrinologyHarbin the First HospitalHarbinChina
| | - Guoping Wang
- Department of EndocrinologySecond Affiliated Hospital of Baotou Medical CollegeBaotouChina
| | - Chengxia Jiang
- Department of EndocrinologyThe Second People's Hospital of YibinYibinChina
| | - Li Liang
- Department of EndocrinologyPeople's Hospital of Liaoning ProvinceShenyangChina
| | - Wei Feng
- Medical DepartmentSanofiShanghaiChina
| | | | - Ting Wang
- Medical DepartmentSanofiShanghaiChina
| | - Xia Zhang
- Medical DepartmentSanofiShanghaiChina
| | - Nan Cui
- Medical DepartmentSanofiShanghaiChina
| | - Yiming Mu
- Department of EndocrinologyThe First Medical Center of Chinese PLA General HospitalBeijingChina
| | - Lixin Guo
- Department of Endocrinology, Beijing HospitalNational Center of GerontologyBeijingChina
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Cost-Effectiveness of Dulaglutide Versus Liraglutide for Management of Type 2 Diabetes Mellitus in Iran. Value Health Reg Issues 2022; 32:54-61. [PMID: 36087364 DOI: 10.1016/j.vhri.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 06/24/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Diabetes mellitus (DM), as one of the most common metabolic diseases, is the ninth leading cause of death globally and imposes heavy costs on the health systems including both costs of treatment and management of secondary complications. This study intended to investigate the cost-effectiveness of dulaglutide compared with liraglutide in the management of patients with type 2 DM in Iran. METHOD We conducted a cost-utility analysis using a 5-state Markov model from the health system perspective, over a 10-year time horizon, in 2018 in Iran. Sensitivity of the model has been evaluated through tornado diagram and using one-way sensitivity analysis. In addition, probabilistic sensitivity analysis has been accomplished using Monte Carlo simulation. RESULTS The average costs of treatment of patients with type 2 DM using the dulaglutide and liraglutide treatment regimens are 17 577.09 and 18 517.54 US dollars per patient, respectively, over a 10-year time horizon. In terms of effectiveness, the average discounted quality-adjusted life-year rates are estimated at 5.560 and 5.403 for the dulaglutide and liraglutide treatment regimens, respectively. The model is mostly sensitive to the price of dulaglutide and liraglutide, the hemoglobin A1c reduction of liraglutide, and the utility resulting from less injection frequency of dulaglutide, respectively. CONCLUSION Dulaglutide, in addition to being more effective, providing 0.156 more quality-adjusted life-years for the patients, reduces costs by 940.45 US dollars per patient over a 10-year time horizon. Therefore, due to the greater effectiveness and lower cost, it is concludable that dulaglutide is the cost-effective (incremental cost-effectiveness ratio = -6028.52) treatment alternative from the health system perspective.
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Zhao X, Ming J, Qu S, Li HJ, Wu J, Ji L, Chen Y. Cost-Effectiveness of Flash Glucose Monitoring for the Management of Patients with Type 1 and Patients with Type 2 Diabetes in China. Diabetes Ther 2021; 12:3079-3092. [PMID: 34689295 PMCID: PMC8586326 DOI: 10.1007/s13300-021-01166-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/27/2021] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION To compare the cost-effectiveness of flash glucose monitoring versus self-monitoring of blood glucose/point of care testing (SMBG/POCT) in both patients with type 1 and patients with type 2 diabetes (T1D/T2D) receiving insulin therapy. METHODS The IQVIA CORE Diabetes Model (version 9.5) was used to project the lifetime costs and health outcomes of flash glucose monitoring and SMBG/POCT from a Chinese societal perspective. We considered both hospital and individual version flash glucose monitoring to reflect the clinical practice in China. The clinical inputs leveraged the outcomes from both clinical trials and real-world studies. Cohort characteristics, intervention costs, treatment-related disutility and mortality were extracted from the literature. We also conducted scenario analyses and probabilistic sensitivity analyses to test the robustness of results. RESULTS Compared with SMBG/POCT using efficacy results from clinical trial, flash glucose monitoring brought the incremental costs of Chinese yuan (CNY) 58,021 and CNY 90,997 and additional quality-adjusted life years (QALYs) of 1.22 and 0.65 for patients with T1D and patients with T2D, respectively. According to the "WHO-CHOICE threshold" of three times the gross domestic product per capita in China (CNY 217,341 in 2020) as cost-effectiveness threshold, flash glucose monitoring was cost-effective for both patients with T1D and patients with T2D with incremental cost-effectiveness ratios (ICER) of CNY 47,636 and CNY 140,297 per QALY gained, respectively. According to the real-world effectiveness data, flash glucose monitoring was dominant for patients with T1D (lower costs and better effectiveness) and cost-effective for patients with T2D with an ICER of CNY 124,169 per QALY gained compared with SMBG/POCT. Scenario analyses and probabilistic sensitivity analyses confirmed the robustness of the results. CONCLUSION Flash glucose monitoring is likely to be considered as a cost-effective strategy compared to SMBG/POCT for Chinese patients with T1D and patients with T2D receiving insulin therapy.
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Affiliation(s)
- Xinran Zhao
- Real World Solutions, IQVIA, Shanghai, China
| | - Jian Ming
- Real World Solutions, IQVIA, Shanghai, China
- National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Shuli Qu
- Real World Solutions, IQVIA, Shanghai, China
| | | | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing, China.
| | - Yingyao Chen
- National Health Commission Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China.
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7
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Yue X, Huang B, Hincapie AL, Wigle PR, Qiu T, Li Y, Morgan EM, Guo JJ. Prescribing Patterns and Impact of Factors Associated with Time to Initial Biologic Therapy among Children with Non-systemic Juvenile Idiopathic Arthritis. Paediatr Drugs 2021; 23:171-182. [PMID: 33651370 DOI: 10.1007/s40272-021-00436-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to examine patterns of initial prescriptions, investigate time to initiation of biologic disease-modifying anti-rheumatic drugs (bDMARDs), and evaluate the impact of clinical and other baseline factors associated with the time to first bDMARD in treating children with newly diagnosed non-systemic juvenile idiopathic arthritis (JIA). METHODS Using longitudinal patient-level data extracted from electronic medical records (EMR) in a large Midwestern pediatric hospital from 2009 to 2018, the initial prescriptions and prescribing patterns of bDMARDs, conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), non-steroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids within 3 months of JIA diagnosis were examined. Kaplan-Meier analyses were performed to assess time to initiation of bDMARDs. Cox proportional hazard models were used to identify factors associated with time to first bDMARD. RESULTS Of 821 children, the proportion of patients with initial csDMARDs increased from 45.3% in 2009 to 60.3% in 2018. Around 57.5% of polyarthritis rheumatoid factor-positive (Poly RF+) patients and 43.2% of polyarthritis rheumatoid factor-negative (Poly RF-) patients received a bDMARD therapy within 3 months of diagnosis, 14.4% as monotherapy and 28.3% in combination with a csDMARD. Among patients who received combination therapy, combination of methotrexate with adalimumab increased from 16.7% in 2009 to 40% in 2018. The proportion of patients treated with adalimumab gradually increased and passed etanercept in 2016. The predictors of earlier initiation of biologic therapy were JIA category enthesitis-related arthritis (ERA) [hazard ratio (HR) vs persistent oligoarthritis 4.82; p < 0.0001], psoriatic arthritis (PsA) (HR 2.46; p = 0.0002), or Poly RF- (HR 2.43; p = 0.0002); the number of joints with limited range of motion (HR 1.02; p = 0.0222), and erythrocyte sedimentation rate (ESR, HR 1.01; p = 0.0033). CONCLUSIONS There was a substantial increase in the proportion of patients receiving the combination of methotrexate and adalimumab among patients receiving combination therapy. Adalimumab overtook etanercept as the most frequently prescribed bDMARD. Multiple factors affect the time to biologic initiation, including the number of joints with limited range of motion, ESR, and JIA category.
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Affiliation(s)
- Xiaomeng Yue
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Ave., Cincinnati, OH, 45267, USA.
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ana L Hincapie
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Ave., Cincinnati, OH, 45267, USA
| | - Patricia R Wigle
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Ave., Cincinnati, OH, 45267, USA
| | - Tingting Qiu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Yuxiang Li
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Esi M Morgan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jeff J Guo
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, 3225 Eden Ave., Cincinnati, OH, 45267, USA
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Lee S, Doktorchik C, Martin EA, D'Souza AG, Eastwood C, Shaheen AA, Naugler C, Lee J, Quan H. Electronic Medical Record-Based Case Phenotyping for the Charlson Conditions: Scoping Review. JMIR Med Inform 2021; 9:e23934. [PMID: 33522976 PMCID: PMC7884219 DOI: 10.2196/23934] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/20/2020] [Accepted: 12/05/2020] [Indexed: 12/16/2022] Open
Abstract
Background Electronic medical records (EMRs) contain large amounts of rich clinical information. Developing EMR-based case definitions, also known as EMR phenotyping, is an active area of research that has implications for epidemiology, clinical care, and health services research. Objective This review aims to describe and assess the present landscape of EMR-based case phenotyping for the Charlson conditions. Methods A scoping review of EMR-based algorithms for defining the Charlson comorbidity index conditions was completed. This study covered articles published between January 2000 and April 2020, both inclusive. Embase (Excerpta Medica database) and MEDLINE (Medical Literature Analysis and Retrieval System Online) were searched using keywords developed in the following 3 domains: terms related to EMR, terms related to case finding, and disease-specific terms. The manuscript follows the Preferred Reporting Items for Systematic reviews and Meta-analyses extension for Scoping Reviews (PRISMA) guidelines. Results A total of 274 articles representing 299 algorithms were assessed and summarized. Most studies were undertaken in the United States (181/299, 60.5%), followed by the United Kingdom (42/299, 14.0%) and Canada (15/299, 5.0%). These algorithms were mostly developed either in primary care (103/299, 34.4%) or inpatient (168/299, 56.2%) settings. Diabetes, congestive heart failure, myocardial infarction, and rheumatology had the highest number of developed algorithms. Data-driven and clinical rule–based approaches have been identified. EMR-based phenotype and algorithm development reflect the data access allowed by respective health systems, and algorithms vary in their performance. Conclusions Recognizing similarities and differences in health systems, data collection strategies, extraction, data release protocols, and existing clinical pathways is critical to algorithm development strategies. Several strategies to assist with phenotype-based case definitions have been proposed.
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Affiliation(s)
- Seungwon Lee
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada.,Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Chelsea Doktorchik
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Elliot Asher Martin
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Adam Giles D'Souza
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Cathy Eastwood
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Abdel Aziz Shaheen
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christopher Naugler
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Joon Lee
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Data Intelligence for Health Lab, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Hude Quan
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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