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Williamson M, Press DJ, Hansen SA, Tomar A, Jhuti GS, Revil C, Gururaj K. Population-level impact of adjuvant trastuzumab emtansine on the incidence of metastatic breast cancer: an epidemiological prediction model of women with HER2-positive early breast cancer and residual disease following neoadjuvant therapy. Breast Cancer 2024; 31:84-95. [PMID: 37907759 PMCID: PMC10764576 DOI: 10.1007/s12282-023-01514-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE Treating early-stage breast cancer (eBC) may delay or prevent subsequent metastatic breast cancer (mBC). In the phase 3 KATHERINE study, women with human epidermal growth factor receptor 2 (HER2)-positive eBC with residual disease following neoadjuvant therapy containing trastuzumab and a taxane experienced 50% reductions in disease recurrence or death when treated with adjuvant trastuzumab emtansine (T-DM1) vs adjuvant trastuzumab. We predicted the population-level impact of adjuvant T-DM1 on mBC occurrence in five European countries (EU5) and Canada from 2021-2030. METHODS An epidemiological prediction model using data from national cancer registries, observational studies, and clinical trials was developed. Assuming 80% population-level uptake of adjuvant treatment, KATHERINE data were extrapolated prospectively to model projections. Robustness was evaluated in alternative scenarios. RESULTS We projected an eligible population of 116,335 women in Canada and the EU5 who may be diagnosed with HER2-positive eBC and have residual disease following neoadjuvant therapy from 2021-2030. In EU5, the cumulative number of women projected to experience relapsed mBC over the 10-year study period was 36,009 vs 27,143 under adjuvant trastuzumab vs T-DM1, a difference of 8,866 women, equivalent to 25% fewer cases with the use of adjuvant T-DM1 in EU5 countries from 2021-2030. Findings were similar for Canada. CONCLUSION Our models predicted greater reductions in the occurrence of relapsed mBC with adjuvant T-DM1 vs trastuzumab in the indicated populations in EU5 and Canada. Introduction of T-DM1 has the potential to reduce population-level disease burden of HER2-positive mBC in the geographies studied.
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Affiliation(s)
- Mellissa Williamson
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA.
- Gilead Sciences, Inc., Foster City, CA, USA.
| | - David J Press
- Genentech, Inc., 1 DNA Way, South San Francisco, CA, USA
| | | | | | | | - Cedric Revil
- F. Hoffmann-La Roche AG, Basel, Switzerland
- Merck Sharp and Dohme, Zurich, Switzerland
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2
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Escribà JM, Banqué M, Macià F, Gálvez J, Esteban L, Pareja L, Clèries R, Sanz X, Castells X, Borrás JM, Ribes J. Detection of incident breast and colorectal cancer cases from an administrative healthcare database in Catalonia, Spain. Clin Transl Oncol 2019; 22:943-952. [PMID: 31586294 DOI: 10.1007/s12094-019-02219-3] [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: 09/04/2019] [Accepted: 09/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To validate the Catalan minimum basic data set (MBDS) of hospital discharges as an information source for detecting incident breast (BC) and colorectal cancer (CRC), against the Hospital del Mar Cancer Registry (RTHMar) in Barcelona (Spain) as the gold standard. METHODS Using ASEDAT software (Analysis, Selection and Extraction of Tumour Data), we identified Catalan public hospital discharge abstracts in patients with a first-time diagnosis of BC and CRC in the years 2005, 2008, and 2011, aggregated by unique patient identifiers and sorted by date. Once merged with the RTHMar database and anonymized, tumour-specific algorithms were validated to extract data on incident cases, tumour stage, surgical treatment, and date of incidence. RESULTS MBDS had a respective sensitivity and positive predictive value (PPV) of 78.0% (564/723) and 90.5% (564/623) for BC case detection; and 83.9% (387/461) and 94.9% (387/408) for CRC case detection. The staging algorithms overestimated the proportion of local-stage cases and underestimated the regional-stage cases in both cancers. When loco-regional stage and surgery were combined, sensitivity and PPV reached 98.3% and 99.8%, respectively, for BC and 96.4% and 98.4% for CRC. The differences between dates of incidence between RTHMar and MBDS were greater for BC cases without initial surgery, whereas they were generally smaller and homogeneous for CRC cases. CONCLUSIONS The MBDS is a valid and efficient instrument to improve the completeness of a hospital-based cancer registry (HBCR), particularly in BC and CRC, which require hospitalization and are predominantly surgical.
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Affiliation(s)
- J M Escribà
- Catalan Cancer Registry, Cancer Planning Directorate, Department of Health, Generalitat de Catalunya, Av. Gran Via 199-203, 1st floor, 08908, L' Hospitalet de Llobregat, Spain. .,Department of Clinical Sciences, University of Barcelona, Campus de Bellvitge, Feixa Llarga s/n, 08907, L' Hospitalet de Llobregat, Barcelona, Spain.
| | - M Banqué
- Unit of Prevention and Cancer Registry, Service of Epidemiology and Evaluation, Parc de Salut Mar, Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.,Anoia Health Consortium, Av. Catalunya 11, 08700, Igualada, Barcelona, Spain
| | - F Macià
- Unit of Prevention and Cancer Registry, Service of Epidemiology and Evaluation, Parc de Salut Mar, Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - J Gálvez
- Catalan Cancer Registry, Cancer Planning Directorate, Department of Health, Generalitat de Catalunya, Av. Gran Via 199-203, 1st floor, 08908, L' Hospitalet de Llobregat, Spain
| | - L Esteban
- Catalan Cancer Registry, Cancer Planning Directorate, Department of Health, Generalitat de Catalunya, Av. Gran Via 199-203, 1st floor, 08908, L' Hospitalet de Llobregat, Spain
| | - L Pareja
- Catalan Cancer Registry, Cancer Planning Directorate, Department of Health, Generalitat de Catalunya, Av. Gran Via 199-203, 1st floor, 08908, L' Hospitalet de Llobregat, Spain
| | - R Clèries
- Catalan Cancer Registry, Cancer Planning Directorate, Department of Health, Generalitat de Catalunya, Av. Gran Via 199-203, 1st floor, 08908, L' Hospitalet de Llobregat, Spain.,Department of Clinical Sciences, University of Barcelona, Campus de Bellvitge, Feixa Llarga s/n, 08907, L' Hospitalet de Llobregat, Barcelona, Spain
| | - X Sanz
- Catalan Cancer Registry, Cancer Planning Directorate, Department of Health, Generalitat de Catalunya, Av. Gran Via 199-203, 1st floor, 08908, L' Hospitalet de Llobregat, Spain
| | - X Castells
- Unit of Prevention and Cancer Registry, Service of Epidemiology and Evaluation, Parc de Salut Mar, Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.,Faculty of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, 08193, Bellaterra, Spain
| | - J M Borrás
- Catalan Cancer Registry, Cancer Planning Directorate, Department of Health, Generalitat de Catalunya, Av. Gran Via 199-203, 1st floor, 08908, L' Hospitalet de Llobregat, Spain.,Department of Clinical Sciences, University of Barcelona, Campus de Bellvitge, Feixa Llarga s/n, 08907, L' Hospitalet de Llobregat, Barcelona, Spain
| | - J Ribes
- Catalan Cancer Registry, Cancer Planning Directorate, Department of Health, Generalitat de Catalunya, Av. Gran Via 199-203, 1st floor, 08908, L' Hospitalet de Llobregat, Spain.,Department of Clinical Sciences, University of Barcelona, Campus de Bellvitge, Feixa Llarga s/n, 08907, L' Hospitalet de Llobregat, Barcelona, Spain
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Oppelt KA, Luttmann S, Kraywinkel K, Haug U. Incidence of advanced colorectal cancer in Germany: comparing claims data and cancer registry data. BMC Med Res Methodol 2019; 19:142. [PMID: 31286896 PMCID: PMC6615087 DOI: 10.1186/s12874-019-0784-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 06/24/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Incidence rates of advanced cancer stages are important, e.g., for monitoring cancer screening programs. However, information from cancer registries on tumor stage is often incomplete. Exemplified by colorectal cancer (CRC), we explored the potential of German claims data to estimate incidence rates of advanced cancer stages. METHODS We used claims data of the German Pharmacoepidemiological Research Database (GePaRD; information on > 20 million persons) to identify incident patients with advanced CRC based on ICD-10 codes for CRC and secondary malignant neoplasms. We calculated annual age-standardized incidence rates (ASIRs) of advanced CRC per 100,000 for the years 2008-2015 stratified by the presence of affected lymph nodes only (C77) vs. distant metastases (C78-C79) and compared them to ASIRs determined using data (2008-2014) from the German Centre for Cancer Registry Data (ZfKD). RESULTS In GePaRD, the ASIRs of advanced CRC per 100,000 in 2014 were 21.5 among men and 14.9 among women. Compared to ZfKD data the ASIR in GePaRD was 2.58 lower in men and 0.27 higher in women (per 100,000) in 2014. Stratification by presence of distant metastases showed divergent patterns: the ASIRs regarding distant metastases were ~ 50% (women) and ~ 30% (men) higher, and the ASIRs regarding affected lymph nodes only were ~ 40% lower in GePaRD as compared to ZfKD. CONCLUSION While ASIRs of advanced CRCs overall agreed well between claims and cancer registry data in 2014, the analyses stratified by presence of distant metastases showed differences. Cancer registries might underestimate ASIRs of CRCs with distant metastases.
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Affiliation(s)
- Katja Anita Oppelt
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Sabine Luttmann
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.,Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Klaus Kraywinkel
- Department for Epidemiology and Health Reporting, German Centre for Cancer Registry Data, Robert Koch-Institute, Berlin, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany. .,Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany.
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Leveraging Linkage of Cohort Studies With Administrative Claims Data to Identify Individuals With Cancer. Med Care 2019; 56:e83-e89. [PMID: 29334524 DOI: 10.1097/mlr.0000000000000875] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In an effort to overcome quality and cost constraints inherent in population-based research, diverse data sources are increasingly being combined. In this paper, we describe the performance of a Medicare claims-based incident cancer identification algorithm in comparison with observational cohort data from the Nurses' Health Study (NHS). METHODS NHS-Medicare linked participants' claims data were analyzed using 4 versions of a cancer identification algorithm across 3 cancer sites (breast, colorectal, and lung). The algorithms evaluated included an update of the original Setoguchi algorithm, and 3 other versions that differed in the data used for prevalent cancer exclusions. RESULTS The algorithm that yielded the highest positive predictive value (PPV) (0.52-0.82) and κ statistic (0.62-0.87) in identifying incident cancer cases utilized both Medicare claims and observational cohort data (NHS) to remove prevalent cases. The algorithm that only used NHS data to inform the removal of prevalent cancer cases performed nearly equivalently in statistical performance (PPV, 0.50-0.79; κ, 0.61-0.85), whereas the version that used only claims to inform the removal of prevalent cancer cases performed substantially worse (PPV, 0.42-0.60; κ, 0.54-0.70), in comparison with the dual data source-informed algorithm. CONCLUSIONS Our findings suggest claims-based algorithms identify incident cancer with variable reliability when measured against an observational cohort study reference standard. Self-reported baseline information available in cohort studies is more effective in removing prevalent cancer cases than are claims data algorithms. Use of claims-based algorithms should be tailored to the research question at hand and the nature of available observational cohort data.
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Tedesco D, Gibertoni D, Rucci P, Hernandez-Boussard T, Rosa S, Bianciardi L, Rolli M, Fantini MP. Impact of rehabilitation on mortality and readmissions after surgery for hip fracture. BMC Health Serv Res 2018; 18:701. [PMID: 30200950 PMCID: PMC6131904 DOI: 10.1186/s12913-018-3523-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 09/05/2018] [Indexed: 12/15/2022] Open
Abstract
Background Hip fracture in elderly patients is a rising global public health concern because of population ageing, and increasing frailty. Long-term morbidity related to poor management of hip fracture is associated with decreased quality of life, survival, and increase in healthcare costs. Receiving postoperative rehabilitation is associated with better outcomes and a higher likelihood of returning to pre-existing level of functioning. However little is known about which postoperative rehabilitation pathways are more effective to optimize patient outcomes. Few studies have analyzed postoperative rehabilitation pathways in a universal healthcare system. The aim of this study is to analyze the impact of post-acute rehabilitation pathways on mortality and readmission in elderly patients undergoing surgery for hip fracture in a large metropolitan area in Italy. Methods In this retrospective cohort study, we analyzed 6-month mortality from admission and 6-month readmission after hospital discharge in patients who underwent surgical repair for hip fracture in the hospitals of the Bologna metropolitan area between 1.1.2013 and 30.6.2014. Data were drawn from the regional hospital discharge records database. Kaplan-Meier estimates and multiple Cox regression were used to analyze mortality as a function of rehabilitation pathways. Multiple logistic regression determined predictors of readmission. Results The study population includes 2208 patients, mostly women (n = 1677, 76%), with a median age of 83.8 years. Hospital rehabilitation was provided to 519 patients (23.5%), 907 (41.1%) received rehabilitation in private inpatient rehabilitation facilities (IRF) accredited by the National Health System, and 782 (35.4%) received no post-acute rehabilitation. Compared with patient receiving hospital rehabilitation, the other groups showed significantly higher mortality risks (no rehabilitation, Hazard Ratio (HR) = 2.19, 95%CI = 1.54–3.12, p < 0.001; IRF rehabilitation, HR = 1.66, 95%CI = 1.54–1.79, p < 0.001). The risk of readmission did not differ significantly among rehabilitation pathways. Conclusions Intensive hospital rehabilitation was significantly associated with a lower risk of mortality compared to IRF rehabilitation and no rehabilitation. Our results may help in the development of evidence-based recommendations aimed to improve resource utilization and quality of care in hip fracture patients. Further research is warranted to investigate the impact of the rehabilitation pathway on other outcomes, such as patients’ functional status and quality of life.
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Affiliation(s)
- Dario Tedesco
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy.
| | - Dino Gibertoni
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Tina Hernandez-Boussard
- Department of Medicine, Stanford University, 1265 Welch Road, 94305, Stanford, California, USA
| | - Simona Rosa
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
| | - Luca Bianciardi
- Rizzoli Orthopedic Institute, Via Giulio Cesare Pupilli, 40138, Bologna, Italy
| | - Maurizia Rolli
- Rizzoli Orthopedic Institute, Via Giulio Cesare Pupilli, 40138, Bologna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Giacomo, 12, 40126, Bologna, Italy
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Abraha I, Montedori A, Serraino D, Orso M, Giovannini G, Scotti V, Granata A, Cozzolino F, Fusco M, Bidoli E. Accuracy of administrative databases in detecting primary breast cancer diagnoses: a systematic review. BMJ Open 2018; 8:e019264. [PMID: 30037859 PMCID: PMC6059263 DOI: 10.1136/bmjopen-2017-019264] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To define the accuracy of administrative datasets to identify primary diagnoses of breast cancer based on the International Classification of Diseases (ICD) 9th or 10th revision codes. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, Web of Science and the Cochrane Library (April 2017). ELIGIBILITY CRITERIA The inclusion criteria were: (a) the presence of a reference standard; (b) the presence of at least one accuracy test measure (eg, sensitivity) and (c) the use of an administrative database. DATA EXTRACTION Eligible studies were selected and data extracted independently by two reviewers; quality was assessed using the Standards for Reporting of Diagnostic accuracy criteria. DATA ANALYSIS Extracted data were synthesised using a narrative approach. RESULTS From 2929 records screened 21 studies were included (data collection period between 1977 and 2011). Eighteen studies evaluated ICD-9 codes (11 of which assessed both invasive breast cancer (code 174.x) and carcinoma in situ (ICD-9 233.0)); three studies evaluated invasive breast cancer-related ICD-10 codes. All studies except one considered incident cases.The initial algorithm results were: sensitivity ≥80% in 11 of 17 studies (range 57%-99%); positive predictive value was ≥83% in 14 of 19 studies (range 15%-98%) and specificity ≥98% in 8 studies. The combination of the breast cancer diagnosis with surgical procedures, chemoradiation or radiation therapy, outpatient data or physician claim may enhance the accuracy of the algorithms in some but not all circumstances. Accuracy for breast cancer based on outpatient or physician's data only or breast cancer diagnosis in secondary position diagnosis resulted low. CONCLUSION Based on the retrieved evidence, administrative databases can be employed to identify primary breast cancer. The best algorithm suggested is ICD-9 or ICD-10 codes located in primary position. TRIAL REGISTRATION NUMBER CRD42015026881.
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Affiliation(s)
- Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
- Innovation and Development, Agenzia Nazionale per i Servizi Sanitari Regionali (Age.Na.S.), Rome, Italy
| | | | - Diego Serraino
- Cancer Epidemiology Unit, IRCCS Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | - Massimiliano Orso
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
- Innovation and Development, Agenzia Nazionale per i Servizi Sanitari Regionali (Age.Na.S.), Rome, Italy
| | - Gianni Giovannini
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Valeria Scotti
- Center for Scientific Documentation, IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Annalisa Granata
- Registro Tumori Regione Campania, ASL Napoli 3 Sud, Brusciano, Italy
| | - Francesco Cozzolino
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Mario Fusco
- Registro Tumori Regione Campania, ASL Napoli 3 Sud, Brusciano, Italy
| | - Ettore Bidoli
- Cancer Epidemiology Unit, IRCCS Centro di Riferimento Oncologico Aviano, Aviano, Italy
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7
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Catching and monitoring clinical innovation through performance indicators. The case of the breast-conserving surgery indicator. BMC Res Notes 2017; 10:288. [PMID: 28716116 PMCID: PMC5513021 DOI: 10.1186/s13104-017-2597-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 07/07/2017] [Indexed: 11/16/2022] Open
Abstract
Background The evolution in the surgical and diagnostic procedures, the attention to women’s preferences, the case mix, and differences in professional practices may lead to a variability in the quality of breast cancer clinical pathway. To catch and manage this variability it is important to use valid measures. The aim of this paper is to examine the concurrent validity of the breast-conserving surgery (BCS) indicator and to provide evidence to guide the quality improvement process. Methods The BCS indicator was calculated using hospital discharge records (HDRs) and was validated against surgical registry (SR) data in a random sample of 336 women undergoing breast cancer surgery in 2012 in two Tuscan teaching hospitals. The concurrent validity of BCS was examined by cross-tabulating patients using the ICD-9 CM codes for breast surgery obtained from the two data sources. Results The analysis, carried out involving breast cancer professionals, highlighted that the large majority of interventions coded as “mastectomies” in HDRs are in fact reconstructing procedures, including nipple-sparing, skin-sparing and skin-reducing mastectomies in SR. These results led us to refine the old algorithm, that calculates the proportion of breast-conserving surgery over the total number of breast interventions, and reclassify breast cancer surgical procedures into three categories: conservative, reconstructive and traditional mastectomy. Based on this new classification algorithm, the percentages of (I) reconstructive interventions were 16% at Florence TH and 38.3% at Pisa TH; (II) breast-conserving interventions were respectively 72.8 and 52.1%; and (III) mastectomies 11.2 and 9.6%. After adjusting for age in a logistic regression model, the percentages of reconstructive interventions at Florence and Pisa were respectively 22 and 34% and those of breast-conserving interventions 63 and 53%. Conclusions Our results indicate that breast cancer care indicators should be refined by distinguishing reconstructive procedures (nipple/skin-sparing surgery with implant or breast tissue expander insertion) from traditional mastectomy. The involvement of breast care professionals in the choice of indicators proved to be crucial to capture the up-to-date breast cancer surgical practice and inform the quality improvement process.
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Ajrouche A, Estellat C, De Rycke Y, Tubach F. Evaluation of algorithms to identify incident cancer cases by using French health administrative databases. Pharmacoepidemiol Drug Saf 2017; 26:935-944. [PMID: 28485129 DOI: 10.1002/pds.4225] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 03/31/2017] [Accepted: 04/17/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE Administrative databases are increasingly being used in cancer observational studies. Identifying incident cancer in these databases is crucial. This study aimed to develop algorithms to estimate cancer incidence by using health administrative databases and to examine the accuracy of the algorithms in terms of national cancer incidence rates estimated from registries. METHODS We identified a cohort of 463 033 participants on 1 January 2012 in the Echantillon Généraliste des Bénéficiaires (EGB; a representative sample of the French healthcare insurance system). The EGB contains data on long-term chronic disease (LTD) status, reimbursed outpatient treatments and procedures, and hospitalizations (including discharge diagnoses, and costly medical procedures and drugs). After excluding cases of prevalent cancer, we applied 15 algorithms to estimate the cancer incidence rates separately for men and women in 2012 and compared them to the national cancer incidence rates estimated from French registries by indirect age and sex standardization. RESULTS The most accurate algorithm for men combined information from LTD status, outpatient anticancer drugs, radiotherapy sessions and primary or related discharge diagnosis of cancer, although it underestimated the cancer incidence (standardized incidence ratio (SIR) 0.85 [0.80-0.90]). For women, the best algorithm used the same definition of the algorithm for men but restricted hospital discharge to only primary or related diagnosis with an additional inpatient procedure or drug reimbursement related to cancer and gave comparable estimates to those from registries (SIR 1.00 [0.94-1.06]). CONCLUSION The algorithms proposed could be used for cancer incidence monitoring and for future etiological cancer studies involving French healthcare databases. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Aya Ajrouche
- APHP, Hôpital Pitié Salpétrière, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Département Biostatistique, Santé Publique et Information Médicale, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, UMR 1123 ECEVE, Paris, France
| | - Candice Estellat
- APHP, Hôpital Pitié Salpétrière, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Département Biostatistique, Santé Publique et Information Médicale, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, UMR 1123 ECEVE, Paris, France
| | - Yann De Rycke
- APHP, Hôpital Pitié Salpétrière, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Département Biostatistique, Santé Publique et Information Médicale, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, UMR 1123 ECEVE, Paris, France
| | - Florence Tubach
- APHP, Hôpital Pitié Salpétrière, Centre de Pharmacoépidémiologie (Cephepi), CIC-1421, Département Biostatistique, Santé Publique et Information Médicale, Paris, France.,Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, UMR 1123 ECEVE, Paris, France.,Université Pierre et Marie Curie, Sorbonne Universités, Paris, France
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Lee WJ, Lee TA, Pickard AS, Shoaibi A, Schumock GT. Using linked electronic data to validate algorithms for health outcomes in administrative databases. J Comp Eff Res 2016; 4:359-66. [PMID: 26274797 DOI: 10.2217/cer.15.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The validity of algorithms used to identify health outcomes in claims-based and administrative data is critical to the reliability of findings from observational studies. The traditional approach to algorithm validation, using medical charts, is expensive and time-consuming. An alternative method is to link the claims data to an external, electronic data source that contains information allowing confirmation of the event of interest. In this paper, we describe this external linkage validation method and delineate important considerations to assess the feasibility and appropriateness of validating health outcomes using this approach. This framework can help investigators decide whether to pursue an external linkage validation method for identifying health outcomes in administrative/claims data.
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Affiliation(s)
- Wan-Ju Lee
- Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.,Center for Pharmacoepidemiology & Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Alan Simon Pickard
- Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.,Center for Pharmacoepidemiology & Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Azadeh Shoaibi
- Center for Drug Evaluation & Research, Office of Medical Policy, US FDA, Silver Spring, MD, USA
| | - Glen T Schumock
- Department of Pharmacy Systems, Outcomes & Policy, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.,Center for Pharmacoepidemiology & Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
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10
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Abraha I, Giovannini G, Serraino D, Fusco M, Montedori A. Validity of breast, lung and colorectal cancer diagnoses in administrative databases: a systematic review protocol. BMJ Open 2016; 6:e010409. [PMID: 26993624 PMCID: PMC4800131 DOI: 10.1136/bmjopen-2015-010409] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Breast, lung and colorectal cancers constitute the most common cancers worldwide and their epidemiology, related health outcomes and quality indicators can be studied using administrative healthcare databases. To constitute a reliable source for research, administrative healthcare databases need to be validated. The aim of this protocol is to perform the first systematic review of studies reporting the validation of International Classification of Diseases 9th and 10th revision codes to identify breast, lung and colorectal cancer diagnoses in administrative healthcare databases. METHODS AND ANALYSIS This review protocol has been developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) 2015 statement. We will search the following databases: MEDLINE, EMBASE, Web of Science and the Cochrane Library, using appropriate search strategies. We will include validation studies that used administrative data to identify breast, lung and colorectal cancer diagnoses or studies that evaluated the validity of breast, lung and colorectal cancer codes in administrative data. The following inclusion criteria will be used: (1) the presence of a reference standard case definition for the disease of interest; (2) the presence of at least one test measure (eg, sensitivity, positive predictive values, etc) and (3) the use of data source from an administrative database. Pairs of reviewers will independently abstract data using standardised forms and will assess quality using a checklist based on the Standards for Reporting of Diagnostic accuracy (STARD) criteria. ETHICS AND DISSEMINATION Ethics approval is not required. We will submit results of this study to a peer-reviewed journal for publication. The results will serve as a guide to identify appropriate case definitions and algorithms of breast, lung and colorectal cancers for researchers involved in validating administrative healthcare databases as well as for outcome research on these conditions that used administrative healthcare databases. TRIAL REGISTRATION NUMBER CRD42015026881.
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Affiliation(s)
- Iosief Abraha
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Gianni Giovannini
- Health Planning Service, Regional Health Authority of Umbria, Perugia, Italy
| | - Diego Serraino
- Epidemiology and Biostatistic Unit, IRCCS Centro di Riferimento Oncologico Aviano, Aviano, Italy
| | - Mario Fusco
- Registro Tumori Regione Campania, ASL NA3 Sud, Brusciano (Na), Italy
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Mahabaleshwarkar R, Khanna R, Banahan B, West-Strum D, Yang Y, Hallam JS. Impact of Preexisting Mental Illnesses on Receipt of Guideline-Consistent Breast Cancer Treatment and Health Care Utilization. Popul Health Manag 2015; 18:449-58. [PMID: 26106925 DOI: 10.1089/pop.2014.0146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study determined the impact of preexisting mental illnesses on guideline-consistent breast cancer treatment and breast cancer-related health care utilization. This was a retrospective, longitudinal, cohort study conducted using data from the 2006-2008 Medicaid Analytic Extract files. The target population for the study consisted of female Medicaid enrollees who were aged 18-64 years and were newly diagnosed with breast cancer in 2007. Guideline-consistent breast cancer treatment was defined according to established guidelines. Breast cancer-related health care use was reported in the form of inpatient, outpatient, and emergency room visits. Statistical analyses consisted of multivariable hierarchical regression models. A total of 2142 newly diagnosed cases of breast cancer were identified. Approximately 38% of these had a preexisting mental illness. Individuals with any preexisting mental illness were less likely to receive guideline-consistent breast cancer treatment compared to those without any preexisting mental illness (adjusted odds ratio: 0.793, 95% confidence interval [CI]: 0.646-0.973). A negative association was observed between preexisting mental illness and breast cancer-related outpatient (adjusted incident rate ratio (AIRR): 0.917, 95% CI: 0.892-0.942) and emergency room utilization (AIRR: 0.842, 95% CI: 0.709-0.999). The association between preexisting mental illnesses and breast cancer-related inpatient utilization was statistically insignificant (AIRR: 0.993, 95% CI: 0.851-1.159). The findings of this study indicate that breast cancer patients with preexisting mental illnesses experience disparities in terms of receipt of guideline-consistent breast cancer treatment and health care utilization. The results of this study highlight the need for more focused care for patients with preexisting mental illness.
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Affiliation(s)
| | - Rahul Khanna
- 2 Department of Pharmacy Administration, School of Pharmacy, The University of Mississippi , University, Mississippi
| | - Benjamin Banahan
- 3 Center for Pharmaceutical Marketing and Management, School of Pharmacy, The University of Mississippi , University, Mississippi
| | - Donna West-Strum
- 2 Department of Pharmacy Administration, School of Pharmacy, The University of Mississippi , University, Mississippi
| | - Yi Yang
- 2 Department of Pharmacy Administration, School of Pharmacy, The University of Mississippi , University, Mississippi
| | - Jeffrey S Hallam
- 4 Department of Social and Behavioral Sciences, College of Public Health, Kent State University , Kent, Ohio
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Showalter TN, Hegarty SE, Rabinowitz C, Maio V, Hyslop T, Dicker AP, Louis DZ. Assessing Adverse Events of Postprostatectomy Radiation Therapy for Prostate Cancer: Evaluation of Outcomes in the Regione Emilia-Romagna, Italy. Int J Radiat Oncol Biol Phys 2015; 91:752-9. [DOI: 10.1016/j.ijrobp.2014.11.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 11/23/2014] [Accepted: 11/30/2014] [Indexed: 01/17/2023]
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Escribà JM, Pareja L, Esteban L, Gálvez J, Melià A, Roca L, Clèries R, Sanz X, Bustins M, Pla MJ, Gil MJ, Borrás JM, Ribes J. Trends in the surgical procedures of women with incident breast cancer in Catalonia, Spain, over a 7-year period (2005-2011). BMC Res Notes 2014; 7:587. [PMID: 25178360 PMCID: PMC4165913 DOI: 10.1186/1756-0500-7-587] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/18/2014] [Indexed: 11/25/2022] Open
Abstract
Background Breast cancer (BC) is the most frequent cancer in women, accounting for 28% of all tumors among women in Catalonia (Spain). Mastectomy has been replaced over time by breast-conserving surgery (BCS) although not as rapidly as might be expected. The aim of this study was to assess the evolution of surgical procedures in incident BC cases in Catalonia between 2005 and 2011, and to analyze variations based on patient and hospital characteristics. Methods We processed data from the Catalonian Health Service’s Acute Hospital Discharge database (HDD) using ASEDAT software (Analysis, Selection and Extraction of Tumor Data) to identify all invasive BC incident cases according to the codes 174.0-174.9 of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) that were attended for the one-year periods in 2005, 2008 and 2011. Patients were classified according to surgical procedures (BCS vs mastectomy, and immediate vs delayed reconstruction), and results were compared among periods according to age, stage, comorbidity and hospital level. Results BC surgical procedures were performed in more than 80% of patients. Surgical cases showed a significant increasing trend in the proportion of women aged 50–69 years, more advanced disease stages, higher comorbidity and they were attended in hospitals of less complexity level throughout the study period. Similar pattern was found for patients treated with BCS, which increased significantly from 67.9% in 2005 to 74.0% in 2011. Simple lymph node removal increased significantly (from 48.8% to 71.4% and from 63.6% to 67.8% for 2005 and 2011 in conservative and radical surgery, respectively). A slightly increase in the proportion of mastectomized young women (from 28% in 2005 to 34% in 2011) was detected, due to multiple factors. About 22% of women underwent post-mastectomy breast reconstruction, this being mostly immediate. Conclusions The use of HDD linked to the ASEDAT allowed us to evaluate BC surgical treatment in Catalonia. A consolidating increasing trend of BCS was observed in women aged 50–69 years, which corresponds with the pattern in most European countries. Among the mastectomized patients, immediate breast reconstructions have risen significantly over the period 2005–2011. Electronic supplementary material The online version of this article (doi:10.1186/1756-0500-7-587) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Josep M Escribà
- Catalonian Cancer Registry, Cancer Planning Directorate, Av, Gran Vía 199-203, 08908 L'Hospitalet de Llobregat, Spain.
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Vichi M, Iafusco D, Galderisi A, Stazi MA, Nisticò L. An easy, fast, effective tool to monitor the incidence of type 1 diabetes among children aged 0-4 years in Italy: the Italian Hospital Discharge Registry (IHDR). Acta Diabetol 2014; 51:287-94. [PMID: 24473635 DOI: 10.1007/s00592-014-0556-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/09/2014] [Indexed: 12/14/2022]
Abstract
National data of type 1 diabetes incidence are currently missing in Italy. To fill this gap, we estimated the national rate of first hospitalizations for type 1 diabetes among children aged 0-4 years and resident in Italy, as well as rates for each of the twenty-one Italian regions. We extracted the first episode of hospitalization in years 2005-2010 from the Italian Hospital Discharge Registry (IHDR). Record-linkage procedure and cleansing data method were applied to exclude prevalent cases and potentially miscoded patients. At the end, 2,250 incident hospitalizations for type 1 diabetes were extracted. In the years 2005-2010, the mean nation-wide first hospitalization rate for type 1 diabetes in children aged 0-4 years was 13.4 (95% CI 12.8-14.0), 14.1 (95% CI 13.3-14.9) in males and 12.7 (95% CI 11.9-13.4) in females. A geographically heterogeneous pattern of incidence was found: even excluding Sardinia, incidence for this age range and calendar period tended to be slightly higher in Southern than in Northern Italy. Our incidence of first hospitalizations corresponds to the estimates of disease incidence obtained with different data sources by other authors in selected Italian regions. We provide, for the first time ever, the estimate of type 1 diabetes incidence for the overall population aged 0-4 years resident in Italy. When methodological cautions are adopted, IHDR emerges as a reasonable proxy of type 1 diabetes incidence and as a cost-effective tool for public health purposes.
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Affiliation(s)
- Monica Vichi
- Statistics Unit, National Centre of Epidemiology, Surveillance, and Health Promotion (CNESPS), Istituto Superiore di Sanità, 00161, Rome, Italy
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Sensi L, Tedesco D, Mimmi S, Rucci P, Pisano E, Pedrini L, McDonald KM, Fantini MP. Hospitalization rates and post-operative mortality for abdominal aortic aneurysm in Italy over the period 2000-2011. PLoS One 2013; 8:e83855. [PMID: 24386294 PMCID: PMC3875532 DOI: 10.1371/journal.pone.0083855] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/10/2013] [Indexed: 12/21/2022] Open
Abstract
Background Recent studies have reported declines in incidence, prevalence and mortality for abdominal aortic aneurysms (AAAs) in various countries, but evidence from Mediterranean countries is lacking. The aim of this study is to examine the trend of hospitalization and post-operative mortality rates for AAAs in Italy during the period 2000–2011, taking into account the introduction of endovascular aneurysm repair (EVAR) in 1990s. Methods This retrospective cohort study was carried out in Emilia-Romagna, an Italian region with 4.5 million inhabitants. A total of 19,673 patients hospitalized for AAAs between 2000 and 2011, were identified from the hospital discharge records (HDR) database. Hospitalization rates, percentage of OSR and EVAR and 30-day mortality rates were calculated for unruptured (uAAAs) and ruptured AAAs (rAAAs). Results Adjusted hospitalization rates decreased on average by 2.9% per year for uAAAs and 3.2% for rAAAs (p<0.001). The temporal trend of 30-day mortality rates remained stable for both groups. The percentage of EVAR for uAAAs increased significantly from 2006 to 2011 (42.7 versus 60.9% respectively, mean change of 3.9% per year, p<0.001). No significant difference in mortality was found between OSR and EVAR for uAAAs and rAAAs. Conclusions The incidence and trend of hospitalization rates for rAAAs and uAAAs decreased significantly in the last decade, while 30-day mortality rates in operated patients remained stable. OSR continued to be the most common surgery in rAAAs, although the gap between OSR and EVAR recently declined. The EVAR technique became the preferred surgery for uAAAs since 2008.
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Affiliation(s)
- Luigi Sensi
- Department of Surgery, Vascular Surgery Unit, Maggiore Hospital, Bologna, Italy
| | - Dario Tedesco
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Stefano Mimmi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Paola Rucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Emilio Pisano
- Department of Surgery, Vascular Surgery Unit, Maggiore Hospital, Bologna, Italy
| | - Luciano Pedrini
- Department of Surgery, Vascular Surgery Unit, Maggiore Hospital, Bologna, Italy
| | - Kathryn M. McDonald
- Stanford Center for Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, California, United States of America
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- * E-mail:
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Sikirica S, Marino M, Gagne JJ, De Palma R, Maio V. Risk of death associated with the use of conventional vs. atypical antipsychotic medications: evaluating the use of the Emilia-Romagna Region database for pharmacoepidemiological studies. J Clin Pharm Ther 2013; 39:38-44. [PMID: 24102411 DOI: 10.1111/jcpt.12099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 08/19/2013] [Indexed: 01/05/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVE Since 2005, a mounting base of evidence has identified that conventional antipsychotic medications are associated with an increased risk of mortality among elderly patients when compared to atypical antipsychotics. This study sought to explore the feasibility of using the Emilia-Romagna Region (RER) database for comparative safety analyses by replicating and refining risk estimates of this well-known drug safety example through meta-analysis. METHODS We identified a cohort of 23 681 Italian RER patients (aged ≥65) who initiated treatment with a conventional or atypical antipsychotic between 1 July 2009 and 30 June 2011. We compared 180-day mortality using Cox proportional hazards models adjusted for risk factors for death, use of other medications and measures of health services utilization intensity, all measured before antipsychotic initiation. We conducted a meta-analysis of studies with similar methods against which to compare our results. RESULTS Among 14 462 and 9219 patients prescribed conventional and atypical antipsychotics, respectively, we observed 2402 (16·6%) and 821 (8·9%) deaths during follow-up. Conventional antipsychotic initiators were older and generally had higher prevalence of outcome risk factors and higher baseline health service use intensity. The crude hazard ratio (HR) was 1·95 [95% confidence interval (CI), 1·80-2·11], which decreased to 1·47 (95% CI, 1·35-1·60) after full adjustment. We identified seven published studies that examined this association using similar methods. The pooled HR from these studies was 1·34 (95% CI, 1·28-1·39). Including our study, the meta-analysis yielded a summary estimate of 1·35 (95% CI, 1·31-1·40) and did not introduce any heterogeneity (I(2) = 0%; P = 0·455). WHAT IS NEW AND CONCLUSIONS Our results support the use of the RER database for pharmacoepidemiological studies and provide an up-to-date and pooled estimate of the magnitude of the association between mortality and conventional vs. atypical antipsychotics.
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Affiliation(s)
- S Sikirica
- School of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
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Kemp A, Preen DB, Saunders C, Holman CDJ, Bulsara M, Rogers K, Roughead EE. Ascertaining invasive breast cancer cases; the validity of administrative and self-reported data sources in Australia. BMC Med Res Methodol 2013; 13:17. [PMID: 23399047 PMCID: PMC3599953 DOI: 10.1186/1471-2288-13-17] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 02/01/2013] [Indexed: 01/10/2023] Open
Abstract
Background Statutory State-based cancer registries are considered the ‘gold standard’ for researchers identifying cancer cases in Australia, but research using self-report or administrative health datasets (e.g. hospital records) may not have linkage to a Cancer Registry and need to identify cases. This study investigated the validity of administrative and self-reported data compared with records in a State-wide Cancer Registry in identifying invasive breast cancer cases. Methods Cases of invasive breast cancer recorded on the New South Wales (NSW) Cancer Registry between July 2004 and December 2008 (the study period) were identified for women in the 45 and Up Study. Registry cases were separately compared with suspected cases ascertained from: i) administrative hospital separations records; ii) outpatient medical service claims; iii) prescription medicines claims; and iv) the 45 and Up Study baseline survey. Ascertainment flags included diagnosis codes, surgeries (e.g. lumpectomy), services (e.g. radiotherapy), and medicines used for breast cancer, as well as self-reported diagnosis. Positive predictive value (PPV), sensitivity and specificity were calculated for flags within individual datasets, and for combinations of flags across multiple datasets. Results Of 143,010 women in the 45 and Up Study, 2039 (1.4%) had an invasive breast tumour recorded on the NSW Cancer Registry during the study period. All of the breast cancer flags examined had high specificity (>97.5%). Of the flags from individual datasets, hospital-derived ‘lumpectomy and diagnosis of invasive breast cancer’ and ‘(lumpectomy or mastectomy) and diagnosis of invasive breast cancer’ had the greatest PPV (89% and 88%, respectively); the later having greater sensitivity (59% and 82%, respectively). The flag with the highest sensitivity and PPV ≥ 85% was 'diagnosis of invasive breast cancer' (both 86%). Self-reported breast cancer diagnosis had a PPV of 50% and sensitivity of 85%, and breast radiotherapy had a PPV of 73% and a sensitivity of 58% compared with Cancer Registry records. The combination of flags with the greatest PPV and sensitivity was ‘(lumpectomy or mastectomy) and (diagnosis of invasive breast cancer or breast radiotherapy)’ (PPV and sensitivity 83%). Conclusions In the absence of Cancer Registry data, administrative and self-reported data can be used to accurately identify cases of invasive breast cancer for sample identification, removing cases from a sample, or risk adjustment. Invasive breast cancer can be accurately identified using hospital-derived diagnosis alone or in combination with surgeries and breast radiotherapy.
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Affiliation(s)
- Anna Kemp
- Centre for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Hwy, Crawley, WA 6009, Australia.
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Lee YYC, Roberts CL, Young J, Dobbins T. Using hospital discharge data to identify incident pregnancy-associated cancers: a validation study. BMC Pregnancy Childbirth 2013; 13:37. [PMID: 23398861 PMCID: PMC3598759 DOI: 10.1186/1471-2393-13-37] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 02/09/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Pregnancy-associated cancer is associated with maternal morbidities and adverse pregnancy outcomes, and is reported to be increasing. Hospital discharge data have the potential to provide timely information on cancer incidence, which is central to evaluation and improvement of clinical care for women. This study aimed to assess the validity of hospital data for identifying incident pregnancy-associated cancers compared with incident cancers from an Australian population-based statutory cancer registry. METHODS Birth data from 2001-2008, comprised 470,277 women with 679,736 maternities, were linked to cancer registry and hospitalisation records to identify newly diagnosed cancers during pregnancy or within 12 months of delivery. Two hospital-identified cancer groups were examined; "index cancer hospitalisation" - first cancer admission per woman per pregnancy and "all cancer hospitalisations" -the total number of hospitalisations with a cancer diagnosis and women could have multiple hospitalisations during pregnancy. The latter replicates a scenario where identification of individuals is not possible and hospitalisations are used as the unit of analysis. RESULTS The incidence of pregnancy-associated cancer (according to cancer registry) was 145.4/100,000 maternities. Incidence of cancer was substantially over-estimated when using hospitalisations as the unit of analysis (incidence rate ratio, IRR 1.7) and under-estimated when using the individual (IRR 0.8). Overall, the sensitivity of "index cancer hospitalisation" was 60.4%, positive predictive value (PPV) 77.7%, specificity and negative predictive value both 100%. Melanoma ascertainment was only 36.1% and breast cancer 62.9%. For other common cancers sensitivities ranged from 72.1% to 78.6% and PPVs 56.4% to 87.3%. CONCLUSION Although hospital data provide another timely source of cancer identification, the validity is insufficient to obtain cancer incidence estimates for the obstetric population.
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Affiliation(s)
- Yuen Yi Cathy Lee
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, New South Wales, Australia
| | - Christine L Roberts
- Clinical and Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, New South Wales, Australia
| | - Jane Young
- Cancer Epidemiology and Services Research Group, University of Sydney, New South Wales, Australia
| | - Timothy Dobbins
- Cancer Epidemiology and Services Research Group, University of Sydney, New South Wales, Australia
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Amin BY, Tu TH, Schairer WW, Na L, Takemoto S, Berven S, Deviren V, Ames C, Chou D, Mummaneni PV. Pitfalls of calculating hospital readmission rates based on nonvalidated administrative data sets. J Neurosurg Spine 2013. [DOI: 10.3171/2012.10.spine12559] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Administrative databases are increasingly being used to establish benchmarks for quality of care and to compare performance across peer hospitals. As proposals for accountable care organizations are being developed, readmission rates will be increasingly scrutinized. The purpose of the present study was to assess whether the all-cause readmissions rate appropriately reflects the University of California, San Francisco (UCSF) Medical Center hospital's clinically relevant readmission rate for spine surgery patients and to identify predictors of readmission.
Methods
Data for 5780 consecutive patient encounters managed by 10 spine surgeons at UCSF Medical Center from October 2007 to June 2011 were abstracted from the University HealthSystem Consortium (UHC) using the Clinical Data Base/Resource Manager. Of these 5780 patient encounters, 281 patients (4.9%) were rehospitalized within 30 days of the previous discharge date. The authors performed an independent chart review to determine clinically relevant reasons for readmission and extracted hospital administrative data to calculate direct costs. Univariate logistic regression analysis was used to evaluate possible predictors of readmission. The two-sample t-test was used to examine the difference in direct cost between readmission and nonreadmission cases.
Results
The main reasons for readmission were infection (39.8%), nonoperative management (13.4%), and planned staged surgery (12.4%). The current all-cause readmission algorithm resulted in an artificially high readmission rate from the clinician's point of view. Based on the authors' manual chart review, 69 cases (25% of the 281 total readmissions) should be excluded because 39 cases (13.9%) were planned staged procedures; 16 cases (5.7%) were unrelated to spine surgery; and 14 surgical cases (5.0%) were cancelled or rescheduled at index admission due to unpredictable reasons. When these 69 cases are excluded, the direct cost of readmission is reduced by 29%. The cost variance is in excess of $3 million. Predictors of readmission were admission status (p < 0.0001), length of stay (p = 0.0001), risk of death (p < 0.0001), and age (p = 0.021).
Conclusions
The authors' findings identify the potential pitfalls in the calculation of readmission rates from administrative data sets. Benchmarking algorithms for defining hospitals' readmission rates must take into account planned staged surgery and eliminate unrelated reasons for readmission. When this is implemented in the calculation method, the readmission rate will be more accurate. Current tools overestimate the clinically relevant readmission rate and cost.
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Affiliation(s)
| | - Tsung-Hsi Tu
- 1Departments of Neurosurgery and
- 3Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital; and
- 4School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | | | - Lumine Na
- 2Orthopedic Surgery, University of California, San Francisco, California
| | - Steven Takemoto
- 2Orthopedic Surgery, University of California, San Francisco, California
| | - Sigurd Berven
- 2Orthopedic Surgery, University of California, San Francisco, California
| | - Vedat Deviren
- 2Orthopedic Surgery, University of California, San Francisco, California
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Clancy Z, Keith SW, Rabinowitz C, Ceccarelli M, Gagne JJ, Maio V. Statins and colorectal cancer risk: a longitudinal study. Cancer Causes Control 2013; 24:777-82. [PMID: 23361340 DOI: 10.1007/s10552-013-0160-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 01/21/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE Studies evaluating the association between statins and colorectal cancer (CRC) have used various methods to address bias and have reported mixed findings. We sought to assess the association in a large cohort of residents in Emilia-Romagna, Italy, using multiple methods to address different sources of confounding. We also sought to explore potential effect measure modification by sex. METHODS We conducted a retrospective cohort study using the 2003-2010 healthcare database of Emilia-Romagna, Italy. We identified all initiators of statins; initiators of glaucoma medications served as the comparison group to account for confounding by healthy user bias. We followed patients longitudinally to identify CRC cases in hospital discharge data. We used multivariable Cox regression analyses to adjust for confounding by CRC risk factors and we conducted a sensitivity analysis using propensity score matching. RESULTS After multivariable adjustment, initiators of statins had a lower incidence rate of CRC as compared to initiators of glaucoma drugs [hazard ratio (HR) 0.79; 95 % CI 0.69-0.90]. In sex-stratified analyses we observed a protective effect in men (HR 0.77; 95 % CI 0.67-0.88) but not in women (HR 0.96; 95 % CI 0.82-1.1). Results were similar in propensity score analyses. CONCLUSIONS After adjusting for observed risk factors, statin initiation versus glaucoma drug initiation was associated with a reduced risk of CRC in men but not in women. While this study is subject to many limitations, it corroborates a previous study that found sex differences in the association between statins and CRC.
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Affiliation(s)
- Zoe Clancy
- Jefferson School of Population Health, Thomas Jefferson University, Philadelphia, PA 19107, USA
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