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Gini R, Pajouheshnia R, Gardarsdottir H, Bennett D, Li L, Gulea C, Wientzek-Fleischmann A, Bazelier MT, Burcu M, Dodd C, Durán CE, Kaplan S, Lanes S, Marinier K, Roberto G, Soman K, Zhou X, Platt R, Setoguchi S, Hall GC. Describing diversity of real world data sources in pharmacoepidemiologic studies: The DIVERSE scoping review. Pharmacoepidemiol Drug Saf 2024; 33:e5787. [PMID: 38724471 DOI: 10.1002/pds.5787] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 08/22/2024]
Abstract
PURPOSE Real-world evidence (RWE) is increasingly used for medical regulatory decisions, yet concerns persist regarding its reproducibility and hence validity. This study addresses reproducibility challenges associated with diversity across real-world data sources (RWDS) repurposed for secondary use in pharmacoepidemiologic studies. Our aims were to identify, describe and characterize practices, recommendations and tools for collecting and reporting diversity across RWDSs, and explore how leveraging diversity could improve the quality of evidence. METHODS In a preliminary phase, keywords for a literature search and selection tool were designed using a set of documents considered to be key by the coauthors. Next, a systematic search was conducted up to December 2021. The resulting documents were screened based on titles and abstracts, then based on full texts using the selection tool. Selected documents were reviewed to extract information on topics related to collecting and reporting RWDS diversity. A content analysis of the topics identified explicit and latent themes. RESULTS Across the 91 selected documents, 12 topics were identified: 9 dimensions used to describe RWDS (organization accessing the data source, data originator, prompt, inclusion of population, content, data dictionary, time span, healthcare system and culture, and data quality), tools to summarize such dimensions, challenges, and opportunities arising from diversity. Thirty-six themes were identified within the dimensions. Opportunities arising from data diversity included multiple imputation and standardization. CONCLUSIONS The dimensions identified across a large number of publications lay the foundation for formal guidance on reporting diversity of data sources to facilitate interpretation and enhance replicability and validity of RWE.
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Affiliation(s)
| | - Romin Pajouheshnia
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
- Department of Epidemiology, RTI Health Solutions, Barcelona, Spain
| | - Helga Gardarsdottir
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
- Department of Data Science & Biostatistics, University Medical Center Utrecht, Utrecht, The Netherlands
- University of Iceland, Reykjavik, Iceland
| | - Dimitri Bennett
- Takeda Development Center Americas, Cambridge, Massachusetts, USA
| | - Lin Li
- Epidemiology and Benefit Risk, Sanofi, Bridgewater, New Jersey, USA
| | - Claudia Gulea
- Center for Observational and Real-World Evidence, MSD, Zürich, Switzerland
| | | | - Marloes T Bazelier
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Mehmet Burcu
- Department of Epidemiology, Merck & Co., Inc., Rahway, New Jersey, USA
| | | | - Carlos E Durán
- Department of Data Science & Biostatistics, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | | | - Kanaka Soman
- Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
| | - Xiaofeng Zhou
- Global Medical Epidemiology, Pfizer Inc. New York, USA
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Bartolini C, Roberto G, Girardi A, Moscatelli V, Spini A, Barchielli A, Bocchia M, Fabbri A, Donnini S, Ziche M, Monti MC, Gini R. Validity of Italian administrative healthcare data in describing the real-world utilization of infusive antineoplastic drugs: the study case of rituximab use in patients treated at the University Hospital of Siena for onco-haematological indications. Front Oncol 2023; 13:1059109. [PMID: 37324023 PMCID: PMC10264685 DOI: 10.3389/fonc.2023.1059109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/18/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Italian administrative healthcare databases are frequently used for studies on real-world drug utilization. However, there is currently a lack of evidence on the accuracy of administrative data in describing the use of infusive antineoplastics. In this study, we used rituximab as a case study to investigate the validity of the regional administrative healthcare database of Tuscany (RAD) in describing the utilization of infusive antineoplastics. Methods We identified patients aged 18 years or older who had received ≥1 rituximab administration between 2011 and 2014 in the onco-haematology ward of the University Hospital of Siena. We retrieved this information from the Hospital Pharmacy Database (HPD-UHS) and linked the person-level information to RAD. Patients who had received ≥1dispensing of rituximab, single administration episodes, and patients treated for non-Hodgkin Lymphoma (nHL) or Chronic Lymphocytic Leukemia (CLL) were identified in RAD and validated using HPD-UHS as the reference standard. We identified the indications of use using algorithms based on diagnostic codes (ICD9CM codes, nHL=200*, 202*; CLL=204.1). We tested 22 algorithms of different complexity for each indication of use and calculated sensitivity and positive predictive value (PPV), with 95% confidence intervals (95%CI), as measures of validity. Results According to HPD-UHS, 307 patients received rituximab for nHL (N=174), CLL (N=21), or other unspecified indications (N=112) in the onco-haematology ward of the University Hospital of Siena. We identified 295 rituximab users in RAD (sensitivity=96.1%), but PPV could not be assessed due to missing information in RAD on dispensing hospital wards. We identified individual rituximab administration episodes with sensitivity=78.6% [95%CI: 76.4-80.6] and PPV=87.6% [95%CI: 86.1-89.2]. Sensitivity of algorithms tested for identifying nHL and CLL ranged from 87.7% to 91.9% for nHL and from 52.4% to 82.7% for CLL. PPV ranged from 64.7% to 66.1% for nHL and from 32.4% to 37.5% for CLL. Discussion Our findings suggest that RAD is a very sensitive source of information for identifying patients who received rituximab for onco-haematological indications. Single administration episodes were identified with good-to-high accuracy. Patients receiving rituximab for nHL were identified with high sensitivity and acceptable PPV, while the validity for CLL was suboptimal.
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Affiliation(s)
- Claudia Bartolini
- Pharmaecoepidemiology Unit, Agenzia Regionale di Sanità della Toscana, Firenze, Italy
| | - Giuseppe Roberto
- Pharmaecoepidemiology Unit, Agenzia Regionale di Sanità della Toscana, Firenze, Italy
| | - Anna Girardi
- Pharmaecoepidemiology Unit, Agenzia Regionale di Sanità della Toscana, Firenze, Italy
| | | | - Andrea Spini
- Department of Life Sciences, Università Degli Studi di Siena, Siena, Italy
| | - Alessandro Barchielli
- Tuscany Cancer Registry, Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy
| | - Monica Bocchia
- Onco-hematology Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alberto Fabbri
- Onco-hematology Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Sandra Donnini
- Department of Life Sciences, Università Degli Studi di Siena, Siena, Italy
| | - Marina Ziche
- Department of Life Sciences, Università Degli Studi di Siena, Siena, Italy
| | - Maria Cristina Monti
- Università di Pavia, Dipartimento di Sanità Pubblica, Medicina Sperimentale e Forense, Pavia, Italy
| | - Rosa Gini
- Pharmaecoepidemiology Unit, Agenzia Regionale di Sanità della Toscana, Firenze, Italy
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Reilev M, Jensen PB, Ranch LS, Egeberg A, Furu K, Gembert K, Hagg D, Haug U, Karlstad Ø, Reutfors J, Schäfer W, Schwartz S, Smits E, Holthius E, Herings R, Trifirò G, Kirchmayer U, Rosa AC, Belleudi V, Gini R, Støvring H, Hallas J. Methodology of the brodalumab assessment of hazards: a multicentre observational safety (BRAHMS) study. BMJ Open 2023; 13:e066057. [PMID: 36725094 PMCID: PMC9896233 DOI: 10.1136/bmjopen-2022-066057] [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] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Safe and effective pharmacological treatment is of paramount importance for treating severe psoriasis. Brodalumab, a monoclonal antibody against interleukin (IL) 17 receptor A, was granted marketing authorisation in the EU in 2017. The European Medicines Agency requested a postauthorisation safety study of brodalumab to address potential safety issues raised during drug development regarding major adverse cardiovascular events, suicidal conduct, cancer and serious infections. METHODS AND ANALYSIS BRodalumab Assessment of Hazards: A Multinational Safety is a multicentre observational safety study of brodalumab running from 2017 to 2029 using population-based healthcare databases from Denmark, Sweden, Norway, Netherlands, Germany and three different centres in Italy. A distributed database network approach is used, such that only aggregate data are exchanged between sites.Two types of designs are used: a case-time-control design to study acute effects of transient treatment and a variation of the new user active comparator design to study the effects of transient or chronic treatment. As comparators, inhibitors of TNF-α, inhibitors of IL-12 and IL-23, and other inhibitors of cytokine IL-17A are included.In the self-controlled case-time-control design, the risk of developing the outcome of interest during periods of brodalumab use is compared within individuals to the risk in periods without use.In the active comparator cohort design, new users of brodalumab are identified and matched to new users of active comparators. Potential baseline confounders are adjusted for by using propensity score modelling. For outcomes that potentially require large cumulative exposure, an adapted active comparator design has been developed. ETHICS AND DISSEMINATION The study is approved by relevant authorities in Denmark, Norway, Sweden, the Netherlands, Germany and Italy in line with the relevant legislation at each site. Data confidentiality is secured by the distributed network approach. Results will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER EUPAS30280.
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Affiliation(s)
- Mette Reilev
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Peter Bjødstrup Jensen
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Lise Skov Ranch
- Biostatistics and Pharmacoepidemiology, LEO Pharma A/S, Ballerup, Denmark
| | - Alexander Egeberg
- Department of dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Kari Furu
- Department of Chronic Diseases, Norwegian Institute of Public Helath, Oslo, Norway
| | - Karin Gembert
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institute, Stockholm, Sweden
| | - David Hagg
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institute, Stockholm, Sweden
| | - Ulrike Haug
- Clinical Epidemiology, Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
- Faculty of Human and Health Science, University of Bremen, Bremen, Germany
| | - Øystein Karlstad
- Department of Chronic Diseases, Norwegian Institute of Public Helath, Oslo, Norway
| | - Johan Reutfors
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institute, Stockholm, Sweden
| | - Wiebke Schäfer
- Clinical Epidemiology, Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Sarina Schwartz
- Clinical Epidemiology, Leibniz-Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Elisabeth Smits
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Emily Holthius
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Ron Herings
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
- Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Rosa Gini
- Epidemiology Unit, Agenzia regionale di sanità della Toscana, Florence, Italy
| | - Henrik Støvring
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Pharmacy and Environmental Medicine, University of Southern Denmark, Odense, Denmark
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Thurin NH, Pajouheshnia R, Roberto G, Dodd C, Hyeraci G, Bartolini C, Paoletti O, Nordeng H, Wallach-Kildemoes H, Ehrenstein V, Dudukina E, MacDonald T, De Paoli G, Loane M, Damase-Michel C, Beau AB, Droz-Perroteau C, Lassalle R, Bergman J, Swart K, Schink T, Cavero-Carbonell C, Barrachina-Bonet L, Gomez-Lumbreras A, Giner-Soriano M, Aragón M, Neville AJ, Puccini A, Pierini A, Ientile V, Trifirò G, Rissmann A, Leinonen MK, Martikainen V, Jordan S, Thayer D, Scanlon I, Georgiou ME, Cunnington M, Swertz M, Sturkenboom M, Gini R. From Inception to ConcePTION: Genesis of a Network to Support Better Monitoring and Communication of Medication Safety During Pregnancy and Breastfeeding. Clin Pharmacol Ther 2021; 111:321-331. [PMID: 34826340 PMCID: PMC9299060 DOI: 10.1002/cpt.2476] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/24/2021] [Indexed: 02/01/2023]
Abstract
In 2019, the Innovative Medicines Initiative (IMI) funded the ConcePTION project-Building an ecosystem for better monitoring and communicating safety of medicines use in pregnancy and breastfeeding: validated and regulatory endorsed workflows for fast, optimised evidence generation-with the vision that there is a societal obligation to rapidly reduce uncertainty about the safety of medication use in pregnancy and breastfeeding. The present paper introduces the set of concepts used to describe the European data sources involved in the ConcePTION project and illustrates the ConcePTION Common Data Model (CDM), which serves as the keystone of the federated ConcePTION network. Based on data availability and content analysis of 21 European data sources, the ConcePTION CDM has been structured with six tables designed to capture data from routine healthcare, three tables for data from public health surveillance activities, three curated tables for derived data on population (e.g., observation time and mother-child linkage), plus four metadata tables. By its first anniversary, the ConcePTION CDM has enabled 13 data sources to run common scripts to contribute to major European projects, demonstrating its capacity to facilitate effective and transparent deployment of distributed analytics, and its potential to address questions about utilization, effectiveness, and safety of medicines in special populations, including during pregnancy and breastfeeding, and, more broadly, in the general population.
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Affiliation(s)
- Nicolas H Thurin
- Bordeaux PharmacoEpi, INSERM CIC-P1401, Univ. Bordeaux, Bordeaux, France
| | - Romin Pajouheshnia
- Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Caitlin Dodd
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Giulia Hyeraci
- Agenzia regionale di sanità della Toscana, Florence, Italy
| | | | - Olga Paoletti
- Agenzia regionale di sanità della Toscana, Florence, Italy
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Helle Wallach-Kildemoes
- PharmacoEpidemiology and Drug Safety Research Group, Department of Pharmacy, and PharmaTox Strategic Initiative, Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway
| | - Vera Ehrenstein
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Elena Dudukina
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Thomas MacDonald
- MEMO Research, School of Medicine, University of Dundee, Dundee, UK
| | - Giorgia De Paoli
- MEMO Research, School of Medicine, University of Dundee, Dundee, UK
| | - Maria Loane
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | | | - Anna-Belle Beau
- INSERM, CERPOP: SPHERE, CIC 1436, Université de Toulouse, Toulouse, France
| | | | - Régis Lassalle
- Bordeaux PharmacoEpi, INSERM CIC-P1401, Univ. Bordeaux, Bordeaux, France
| | - Jorieke Bergman
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Karin Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, The Netherlands
| | - Tania Schink
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Clara Cavero-Carbonell
- Fundació per al Foment de la Investigació Sanitaria i Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Laia Barrachina-Bonet
- Fundació per al Foment de la Investigació Sanitaria i Biomédica de la Comunitat Valenciana (FISABIO), Valencia, Spain
| | - Ainhoa Gomez-Lumbreras
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Maria Giner-Soriano
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - María Aragón
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Amanda J Neville
- IMER Registry (Emila Romagna Registry of Birth Defects), Center of Epidemiology for Clinical Research, University of Ferrara, Ferrara, Italy
| | - Aurora Puccini
- Drug Policy Service, Emilia Romagna Region Health Authority, Bologna, Italy
| | - Anna Pierini
- Epidemiology of Rare Diseases and Congenital Anomalies Unit, National Research Council-Institute of Clinical Physiology (CNR-IFC), Pisa, Italy
| | - Valentina Ientile
- Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Messina, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | | | | | - Sue Jordan
- Faculty of Health and Life Science, Swansea University, Swansea, UK
| | - Daniel Thayer
- Faculty of Health and Life Science, Swansea University, Swansea, UK
| | - Ieuan Scanlon
- Faculty of Health and Life Science, Swansea University, Swansea, UK
| | | | | | - Morris Swertz
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Miriam Sturkenboom
- Department Datascience and Biostatistics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rosa Gini
- Agenzia regionale di sanità della Toscana, Florence, Italy
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Real-World Utilization of Target- and Immunotherapies for Lung Cancer: A Scoping Review of Studies Based on Routinely Collected Electronic Healthcare Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147679. [PMID: 34300130 PMCID: PMC8305284 DOI: 10.3390/ijerph18147679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 01/01/2023]
Abstract
Routinely collected electronic healthcare data (rcEHD) have a tremendous potential for enriching pre-marketing evidence on target- and immunotherapies used to treat lung cancer (LC). A scoping review was performed to provide a structured overview of available rcEHD-based studies on this topic and to support the execution of future research by facilitating access to pertinent literature both for study design and benchmarking. Eligible studies published between 2016 and 2020 in PubMed and ISI Web of Science were searched. Data source and study characteristics, as well as evidence on drug utilization and survival were extracted. Thirty-two studies were included. Twenty-six studies used North American data, while three used European data only. Thirteen studies linked ≥1 data source types among administrative/claims data, cancer registries and medical/health records. Twenty-nine studies retrieved cancer-related information from medical records/cancer registries and 31 studies retrieved information on drug utilization or survival from medical records or administrative/claim data. Most part of studies concerned non-small-cell-LC patients (29 out of 32) while none focused on small-cell-LC. Study cohorts ranged between 85 to 81,983 patients. Only two studies described first-line utilization of immunotherapies. Results from this review will serve as a starting point for the execution of future rcEHD-based studies on innovative LC pharmacotherapies.
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Perera G, Rijnbeek PR, Alexander M, Ansell D, Avillach P, Duarte-Salles T, Gordon MF, Lapi F, Mayer MA, Pasqua A, Pedersen L, van Der Lei J, Visser PJ, Stewart R. Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case-control study using European electronic health records. BMJ Open 2020; 10:e038753. [PMID: 33191253 PMCID: PMC7668358 DOI: 10.1136/bmjopen-2020-038753] [Citation(s) in RCA: 7] [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] [Received: 04/14/2020] [Revised: 06/16/2020] [Accepted: 09/17/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The objective of the study is to compare body mass index (BMI), systolic/diastolic blood pressure (SBP/DBP) and serum total cholesterol levels between dementia cases and controls at multiple time intervals prior to dementia onset, and to test time interval as a modifying factor for these associations. DESIGN Case-control study. SETTING Six European electronic health records databases. PARTICIPANTS 291 780 cases at the date of first-recorded dementia diagnosis, compared with 29 170 549 controls randomly selected from the same databases, age matched and sex matched at this index date. EXPOSURE The following measures were extracted whenever recorded within each dataset: BMI (kg/m2), SBP and DBP (mm Hg) and serum total cholesterol (mmol/L). Levels for each of these variables were defined within six 2-year time intervals over the 12 years prior to the index date. MAIN OUTCOMES Case-control differences in exposures of interest were modelled for each time period and adjusted for demographic and clinical factors (ischaemic/unspecified stroke, type 2 diabetes mellitus, acute myocardial infarction, hypertension diagnosis, antihypertensive medication, cholesterol-lowering medication). Coefficients and interactions with time period were meta-analysed across the six databases. RESULTS Mean BMI (coefficient -1.16 kg/m2; 95% CI -1.38 to 0.93) and SBP (-2.83 mm Hg; 95% CI -4.49 to -1.16) were lower in cases at diagnosis, and case-control differences were greater in more recent time periods, as indicated by significant case-x-time interaction and case-x-time-squared interaction terms. Time variations in coefficients for cholesterol levels were less consistent between databases and those for DBP were largely not significant. CONCLUSION Routine clinical data show emerging divergence in levels of BMI and SBP prior to the diagnosis of dementia but less evidence for DBP or total cholesterol levels. These divergences should receive at least some consideration in routine dementia risk screening, although underlying mechanisms still require further investigation.
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Affiliation(s)
- Gayan Perera
- Psychological Medicine, King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
| | - P R Rijnbeek
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - David Ansell
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Paul Avillach
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
- Aarhus University, Aarhus, Denmark
| | | | - Mark Forrest Gordon
- Specialty Clinical Development, Neurology and Psychiatry, Teva Pharmaceuticals USA Inc, North Wales, Pennsylvania, USA
| | - Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | | | - Alessandro Pasqua
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Johan van Der Lei
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Pieter Jelle Visser
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
- Department of Neurology, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Neurobiology, Karolinska Institutet, Stockholm, Sweden
| | - Robert Stewart
- Psychological Medicine, King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Gini R, Sturkenboom MCJ, Sultana J, Cave A, Landi A, Pacurariu A, Roberto G, Schink T, Candore G, Slattery J, Trifirò G. Different Strategies to Execute Multi-Database Studies for Medicines Surveillance in Real-World Setting: A Reflection on the European Model. Clin Pharmacol Ther 2020; 108:228-235. [PMID: 32243569 PMCID: PMC7484985 DOI: 10.1002/cpt.1833] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/13/2020] [Indexed: 12/18/2022]
Abstract
Although postmarketing studies conducted in population-based databases often contain information on patients in the order of millions, they can still be underpowered if outcomes or exposure of interest is rare, or the interest is in subgroup effects. Combining several databases might provide the statistical power needed. A multi-database study (MDS) uses at least two healthcare databases, which are not linked with each other at an individual person level, with analyses carried out in parallel across each database applying a common study protocol. Although many MDSs have been performed in Europe in the past 10 years, there is a lack of clarity on the peculiarities and implications of the existing strategies to conduct them. In this review, we identify four strategies to execute MDSs, classified according to specific choices in the execution: (A) local analyses, where data are extracted and analyzed locally, with programs developed by each site; (B) sharing of raw data, where raw data are locally extracted and transferred without analysis to a central partner, where all the data are pooled and analyzed; (C) use of a common data model with study-specific data, where study-specific data are locally extracted, loaded into a common data model, and processed locally with centrally developed programs; and (D) use of general common data model, where all local data are extracted and loaded into a common data model, prior to and independent of any study protocol, and protocols are incorporated in centrally developed programs that run locally. We illustrate differences between strategies and analyze potential implications.
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Affiliation(s)
- Rona Gini
- Agenzia regionale di sanità della ToscanaFlorenceItaly
| | | | | | - Alison Cave
- European Medicines AgencyAmsterdamThe Netherlands
| | - Annalisa Landi
- Fondazione per la Ricerca Farmacologica Gianni Benzi OnlusValenzanoItaly
- Teddy European Network of Excellence for Paediatric Clinical ResearchPaviaItaly
| | | | | | - Tania Schink
- Leibniz Institute for Prevention Research and EpidemiologyBremenGermany
| | | | - Jim Slattery
- European Medicines AgencyAmsterdamThe Netherlands
| | - Gianluca Trifirò
- Department of Biomedical and Dental Sciences and Morphofunctional ImagingUniversità di MessinaMessinaItaly
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Musacchio N, Giancaterini A, Guaita G, Ozzello A, Pellegrini MA, Ponzani P, Russo GT, Zilich R, de Micheli A. Artificial Intelligence and Big Data in Diabetes Care: A Position Statement of the Italian Association of Medical Diabetologists. J Med Internet Res 2020; 22:e16922. [PMID: 32568088 PMCID: PMC7338925 DOI: 10.2196/16922] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/09/2020] [Accepted: 04/12/2020] [Indexed: 12/24/2022] Open
Abstract
Since the last decade, most of our daily activities have become digital. Digital health takes into account the ever-increasing synergy between advanced medical technologies, innovation, and digital communication. Thanks to machine learning, we are not limited anymore to a descriptive analysis of the data, as we can obtain greater value by identifying and predicting patterns resulting from inductive reasoning. Machine learning software programs that disclose the reasoning behind a prediction allow for “what-if” models by which it is possible to understand if and how, by changing certain factors, one may improve the outcomes, thereby identifying the optimal behavior. Currently, diabetes care is facing several challenges: the decreasing number of diabetologists, the increasing number of patients, the reduced time allowed for medical visits, the growing complexity of the disease both from the standpoints of clinical and patient care, the difficulty of achieving the relevant clinical targets, the growing burden of disease management for both the health care professional and the patient, and the health care accessibility and sustainability. In this context, new digital technologies and the use of artificial intelligence are certainly a great opportunity. Herein, we report the results of a careful analysis of the current literature and represent the vision of the Italian Association of Medical Diabetologists (AMD) on this controversial topic that, if well used, may be the key for a great scientific innovation. AMD believes that the use of artificial intelligence will enable the conversion of data (descriptive) into knowledge of the factors that “affect” the behavior and correlations (predictive), thereby identifying the key aspects that may establish an improvement of the expected results (prescriptive). Artificial intelligence can therefore become a tool of great technical support to help diabetologists become fully responsible of the individual patient, thereby assuring customized and precise medicine. This, in turn, will allow for comprehensive therapies to be built in accordance with the evidence criteria that should always be the ground for any therapeutic choice.
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Affiliation(s)
| | - Annalisa Giancaterini
- Diabetology Service, Muggiò Polyambulatory, Azienda Socio Sanitaria Territoriale, Monza, Italy
| | - Giacomo Guaita
- Diabetology, Endocrinology and Metabolic Diseases Service, Azienda Tutela Salute Sardegna-Azienda Socio Sanitaria Locale, Carbonia, Italy
| | - Alessandro Ozzello
- Departmental Structure of Endocrine Diseases and Diabetology, Azienda Sanitaria Locale TO3, Pinerolo, Italy
| | - Maria A Pellegrini
- Italian Association of Diabetologists, Rome, Italy.,New Coram Limited Liability Company, Udine, Italy
| | - Paola Ponzani
- Operative Unit of Diabetology, La Colletta Hospital, Azienda Sanitaria Locale 3, Genova, Italy
| | - Giuseppina T Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | - Alberto de Micheli
- Associazione dei Cavalieri Italiani del Sovrano Militare Ordine di Malta, Genova, Italy
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Lovestone S. The European medical information framework: A novel ecosystem for sharing healthcare data across Europe. Learn Health Syst 2020; 4:e10214. [PMID: 32313838 PMCID: PMC7156868 DOI: 10.1002/lrh2.10214] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/27/2019] [Accepted: 11/29/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The European medical information framework (EMIF) was an Innovative Medicines Initiative project jointly supported by the European Union and the European Federation of Pharmaceutical Industries and Associations, that generated a common technology and governance framework to identify, assess and (re)use healthcare data, to facilitate real-world data research. The objectives of EMIF included providing a unified platform to support a wide range of studies within two verification programmes-Alzheimer's disease (EMIF-AD), and metabolic consequences of obesity (EMIF-MET). METHODS The EMIF platform was built around two main data-types: electronic health record data and research cohort data, and the platform architecture composed of a set of tools designed to enable data discovery and characterisation. This included the EMIF catalogue, which allowed users to find relevant data sources, including the data-types collected. Data harmonisation via a common data model were central to the project especially for population data sources. EMIF also developed an ethical code of practice to ensure data protection, patient confidentiality and compliance with the European Data Protection Directive, and GDPR. RESULTS Currently 18 population-based disease agnostic and 60 cohort-based Alzheimer's data partners from across 14 countries are contained within the catalogue, and this will continue to expand. The work conducted in EMIF-AD and EMIF-MET includes standardizing cohorts, summarising baseline characteristics of patients, developing diagnostic algorithms, epidemiological studies, identifying and validating novel biomarkers and selecting potential patient samples for pharmacological intervention. CONCLUSIONS EMIF was designed to provide a sustainable model as demonstrated by the sustainability plans for EMIF-AD. Although network-wide studies using EMIF were not conducted during this project to evaluate its sustainability, learning from EMIF will be used in the follow-on IMI-2 project, European Health Data and Evidence Network (EHDEN). Furthermore, EMIF has facilitated collaborations between partners and continues to promote a wider adoption of principles, technology and architecture through some of its continued work.
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Affiliation(s)
- Simon Lovestone
- Neurodegeneration, Janssen R&D, Janssen Pharmaceutica, Beerse, Belgium
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10
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Longato E, Di Camillo B, Sparacino G, Saccavini C, Avogaro A, Fadini GP. Diabetes diagnosis from administrative claims and estimation of the true prevalence of diabetes among 4.2 million individuals of the Veneto region (North East Italy). Nutr Metab Cardiovasc Dis 2020; 30:84-91. [PMID: 31757572 DOI: 10.1016/j.numecd.2019.08.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 08/23/2019] [Accepted: 08/23/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Diabetes can often remain undiagnosed or unregistered in administrative databases long after its onset, even when laboratory test results meet diagnostic criteria. In the present work, we analyse healthcare data of the Veneto Region, North East Italy, with the aims of: (i) developing an algorithm for the identification of diabetes from administrative claims (4,236,007 citizens), (ii) assessing its reliability by comparing its performance with the gold standard clinical diagnosis from a clinical database (7525 patients), (iii) combining the algorithm and the laboratory data of the regional Health Information Exchange (rHIE) system (543,520 subjects) to identify undiagnosed diabetes, and (iv) providing a credible estimate of the true prevalence of diabetes in Veneto. METHODS AND RESULTS The proposed algorithm for the identification of diabetes was fed by administrative data related to drug dispensations, outpatient visits, and hospitalisations. Evaluated against a clinical database, the algorithm achieved 95.7% sensitivity, 87.9% specificity, and 97.6% precision. To identify possible cases of undiagnosed diabetes, we applied standard diagnostic criteria to the laboratory test results of the subjects who, according to the algorithm, had no diabetes-related claims. Using a simplified probabilistic model, we corrected our claims-based estimate of known diabetes (6.17% prevalence; 261,303 cases) to account for undiagnosed cases, yielding an estimated total prevalence of 7.50%. CONCLUSION We herein validated an algorithm for the diagnosis of diabetes using administrative claims against the clinical diagnosis. Together with rHIE laboratory data, this allowed to identify possibly undiagnosed diabetes and estimate the true prevalence of diabetes in Veneto.
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Affiliation(s)
- Enrico Longato
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Barbara Di Camillo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giovanni Sparacino
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Claudio Saccavini
- Arsenàl.IT, Veneto's Research Centre for eHealth Innovation, Treviso, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova, Italy
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Geneviève LD, Martani A, Mallet MC, Wangmo T, Elger BS. Factors influencing harmonized health data collection, sharing and linkage in Denmark and Switzerland: A systematic review. PLoS One 2019; 14:e0226015. [PMID: 31830124 PMCID: PMC6907832 DOI: 10.1371/journal.pone.0226015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/18/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The digitalization of medicine has led to a considerable growth of heterogeneous health datasets, which could improve healthcare research if integrated into the clinical life cycle. This process requires, amongst other things, the harmonization of these datasets, which is a prerequisite to improve their quality, re-usability and interoperability. However, there is a wide range of factors that either hinder or favor the harmonized collection, sharing and linkage of health data. OBJECTIVE This systematic review aims to identify barriers and facilitators to health data harmonization-including data sharing and linkage-by a comparative analysis of studies from Denmark and Switzerland. METHODS Publications from PubMed, Web of Science, EMBASE and CINAHL involving cross-institutional or cross-border collection, sharing or linkage of health data from Denmark or Switzerland were searched to identify the reported barriers and facilitators to data harmonization. RESULTS Of the 345 projects included, 240 were single-country and 105 were multinational studies. Regarding national projects, a Swiss study reported on average more barriers and facilitators than a Danish study. Barriers and facilitators of a technical nature were most frequently reported. CONCLUSION This systematic review gathered evidence from Denmark and Switzerland on barriers and facilitators concerning data harmonization, sharing and linkage. Barriers and facilitators were strictly interrelated with the national context where projects were carried out. Structural changes, such as legislation implemented at the national level, were mirrored in the projects. This underlines the impact of national strategies in the field of health data. Our findings also suggest that more openness and clarity in the reporting of both barriers and facilitators to data harmonization constitute a key element to promote the successful management of new projects using health data and the implementation of proper policies in this field. Our study findings are thus meaningful beyond these two countries.
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Affiliation(s)
| | - Andrea Martani
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | | | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Bernice Simone Elger
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- University Center of Legal Medicine, University of Geneva, Geneva, Switzerland
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12
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Gini R, Dodd CN, Bollaerts K, Bartolini C, Roberto G, Huerta-Alvarez C, Martín-Merino E, Duarte-Salles T, Picelli G, Tramontan L, Danieli G, Correa A, McGee C, Becker BFH, Switzer C, Gandhi-Banga S, Bauwens J, van der Maas NAT, Spiteri G, Sdona E, Weibel D, Sturkenboom M. Quantifying outcome misclassification in multi-database studies: The case study of pertussis in the ADVANCE project. Vaccine 2019; 38 Suppl 2:B56-B64. [PMID: 31677950 DOI: 10.1016/j.vaccine.2019.07.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/28/2019] [Accepted: 07/10/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Accelerated Development of VAccine beNefit-risk Collaboration in Europe (ADVANCE) is a public-private collaboration aiming to develop and test a system for rapid benefit-risk (B/R) monitoring of vaccines using European healthcare databases. Event misclassification can result in biased estimates. Using different algorithms for identifying cases of Bordetella pertussis (BorPer) infection as a test case, we aimed to describe a strategy to quantify event misclassification, when manual chart review is not feasible. METHODS Four participating databases retrieved data from primary care (PC) setting: BIFAP: (Spain), THIN and RCGP RSC (UK) and PEDIANET (Italy); SIDIAP (Spain) retrieved data from both PC and hospital settings. BorPer algorithms were defined by healthcare setting, data domain (diagnoses, drugs, or laboratory tests) and concept sets (specific or unspecified pertussis). Algorithm- and database-specific BorPer incidence rates (IRs) were estimated in children aged 0-14 years enrolled in 2012 and 2014 and followed up until the end of each calendar year and compared with IRs of confirmed pertussis from the ECDC surveillance system (TESSy). Novel formulas were used to approximate validity indices, based on a small set of assumptions. They were applied to approximately estimate positive predictive value (PPV) and sensitivity in SIDIAP. RESULTS The number of cases and the estimated BorPer IRs per 100,000 person-years in PC, using data representing 3,173,268 person-years, were 0 (IR = 0.0), 21 (IR = 4.3), 21 (IR = 5.1), 79 (IR = 5.7), and 2 (IR = 2.3) in BIFAP, SIDIAP, THIN, RCGP RSC and PEDIANET respectively. The IRs for combined specific/unspecified pertussis were higher than TESSy, suggesting that some false positives had been included. In SIDIAP the estimated IR was 45.0 when discharge diagnoses were included. The sensitivity and PPV of combined PC specific and unspecific diagnoses for BorPer cases in SIDIAP were approximately 85% and 72%, respectively. CONCLUSION Retrieving BorPer cases using only specific concepts has low sensitivity in PC databases, while including cases retrieved by unspecified concepts introduces false positives, which were approximately estimated to be 28% in one database. The share of cases that cannot be retrieved from a PC database because they are only seen in hospital was approximately estimated to be 15% in one database. This study demonstrated that quantifying the impact of different event-finding algorithms across databases and benchmarking with disease surveillance data can provide approximate estimates of algorithm validity.
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Affiliation(s)
- Rosa Gini
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy.
| | - Caitlin N Dodd
- Erasmus University Medical Center, Post Box 2040, 3000 CA Rotterdam, Netherlands; Julius Global Health, University Medical Center, Utrecht, Heidelberglaan 100, the Netherlands
| | - Kaatje Bollaerts
- P95 Epidemiology and Pharmacovigilance, Koning Leopold III laan 1, 3001 Heverlee, Belgium.
| | - Claudia Bartolini
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy.
| | - Giuseppe Roberto
- Agenzia regionale di sanità della Toscana, Osservatorio di epidemiologia, Florence, Italy.
| | | | - Elisa Martín-Merino
- BIFAP Database, Spanish Agency of Medicines and Medical Devices, Madrid, Spain.
| | - Talita Duarte-Salles
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain.
| | - Gino Picelli
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (PEDIANET), Padova, Italy.
| | - Lara Tramontan
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (PEDIANET), Padova, Italy; Consorzio Arsenal.IT, Veneto Region, Italy.
| | - Giorgia Danieli
- Epidemiological Information for Clinical Research from an Italian Network of Family Paediatricians (PEDIANET), Padova, Italy; Consorzio Arsenal.IT, Veneto Region, Italy
| | - Ana Correa
- University of Surrey, Guildford, Surrey GU2 7XH, UK.
| | - Chris McGee
- University of Surrey, Guildford, Surrey GU2 7XH, UK; Royal College of General Practitioners, Research and Surveillance Centre, 30 Euston Square, London NW1 2FB, UK.
| | - Benedikt F H Becker
- Erasmus University Medical Center, Post Box 2040, 3000 CA Rotterdam, Netherlands.
| | | | | | - Jorgen Bauwens
- University Children's Hospital, Basel, Switzerland; University of Basel, Switzerland; Brighton Collaboration Foundation, Switzerland.
| | | | - Gianfranco Spiteri
- European Centre for Disease Prevention and Control, Gustav III's Boulevard 40, 16973 Solna, Sweden.
| | - Emmanouela Sdona
- European Centre for Disease Prevention and Control, Gustav III's Boulevard 40, 16973 Solna, Sweden
| | - Daniel Weibel
- Erasmus University Medical Center, Post Box 2040, 3000 CA Rotterdam, Netherlands.
| | - Miriam Sturkenboom
- Julius Global Health, University Medical Center, Utrecht, Heidelberglaan 100, the Netherlands; P95 Epidemiology and Pharmacovigilance, Koning Leopold III laan 1, 3001 Heverlee, Belgium; VACCINE.GRID Foundation, Spitalstrasse 33, Basel, Switzerland.
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TASKA: A modular task management system to support health research studies. BMC Med Inform Decis Mak 2019; 19:121. [PMID: 31266480 PMCID: PMC6604289 DOI: 10.1186/s12911-019-0844-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 06/20/2019] [Indexed: 11/25/2022] Open
Abstract
Background Many healthcare databases have been routinely collected over the past decades, to support clinical practice and administrative services. However, their secondary use for research is often hindered by restricted governance rules. Furthermore, health research studies typically involve many participants with complementary roles and responsibilities which require proper process management. Results From a wide set of requirements collected from European clinical studies, we developed TASKA, a task/workflow management system that helps to cope with the socio-technical issues arising when dealing with multidisciplinary and multi-setting clinical studies. The system is based on a two-layered architecture: 1) the backend engine, which follows a micro-kernel pattern, for extensibility, and RESTful web services, for decoupling from the web clients; 2) and the client, entirely developed in ReactJS, allowing the construction and management of studies through a graphical interface. TASKA is a GNU GPL open source project, accessible at https://github.com/bioinformatics-ua/taska. A demo version is also available at https://bioinformatics.ua.pt/taska. Conclusions The system is currently used to support feasibility studies across several institutions and countries, in the context of the European Medical Information Framework (EMIF) project. The tool was shown to simplify the set-up of health studies, the management of participants and their roles, as well as the overall governance process.
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Affiliation(s)
- Dipak Kalra
- Department of Medical Informatics and Statistics, University of Gent, Gent 9000, Belgium
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15
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Raschi E, Poluzzi E, Fadini GP, Marchesini G, De Ponti F. Observational research on sodium glucose co-transporter-2 inhibitors: A real breakthrough? Diabetes Obes Metab 2018; 20:2711-2723. [PMID: 30003655 PMCID: PMC6283243 DOI: 10.1111/dom.13468] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 07/04/2018] [Accepted: 07/10/2018] [Indexed: 12/14/2022]
Abstract
Sodium glucose co-transporter-2 inhibitors have attracted the interest of the scientific community following the results from dedicated cardiovascular outcome trials, which demonstrated remarkable reduction in all-cause mortality and other cardiovascular (CV) endpoints with empagliflozin and canagliflozin. These impressive results raised further expectations on real world data from large observational cohort studies. They were designed to address the possible existence of a class effect, and the uncertainty on whether this benefit can be extended from secondary to primary CV prevention of patients with type 2 diabetes. In this review, we collated data from existing observational studies (including the celebrated CVD-REAL cohorts) and critically appraised results and methodological issues with the aim of providing clinical insight, including unsettled aspects, and proposing a research agenda for future investigations.
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Affiliation(s)
- Emanuel Raschi
- Pharmacology Unit, Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | - Elisabetta Poluzzi
- Pharmacology Unit, Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | | | - Giulio Marchesini
- Unit of Metabolic Diseases & Clinical Dietetics, Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
| | - Fabrizio De Ponti
- Pharmacology Unit, Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
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Pacurariu A, Plueschke K, McGettigan P, Morales DR, Slattery J, Vogl D, Goedecke T, Kurz X, Cave A. Electronic healthcare databases in Europe: descriptive analysis of characteristics and potential for use in medicines regulation. BMJ Open 2018; 8:e023090. [PMID: 30185579 PMCID: PMC6129090 DOI: 10.1136/bmjopen-2018-023090] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Electronic healthcare databases (EHDs) are useful tools for drug development and safety evaluation but their heterogeneity of structure, validity and access across Europe complicates the conduct of multidatabase studies. In this paper, we provide insight into available EHDs to support regulatory decisions on medicines. METHODS EHDs were identified from publicly available information from the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance resources database, textbooks and web-based searches. Databases were selected using criteria related to accessibility, longitudinal dimension, recording of exposure and outcomes, and generalisability. Extracted information was verified with the database owners. RESULTS A total of 34 EHDs were selected after applying key criteria relevant for regulatory purposes. The most represented regions were Northern, Central and Western Europe. The most frequent types of data source were electronic medical records (44.1%) and record linkage systems (29.4%). The median number of patients registered in the 34 data sources was 5 million (range 0.07-15 million) while the median time covered by a database was 18.5 years. Paediatric patients were included in 32 databases (94%). Completeness of information on drug exposure was variable. Published validation studies were found for only 17 databases (50%). Some level of access exists for 25 databases (73.5%), and 23 databases (67.6%) can be linked through a personal identification number to other databases with parent-child linkage possible in 7 (21%) databases. Eight databases (23.5%) were already transformed or were in the process of being transformed into a common data model that could facilitate multidatabase studies. CONCLUSION A Few European databases meet minimal regulatory requirements and are readily available to be used in a regulatory context. Accessibility and validity information of the included information needs to be improved. This study confirmed the fragmentation, heterogeneity and lack of transparency existing in many European EHDs.
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Affiliation(s)
- Alexandra Pacurariu
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
| | - Kelly Plueschke
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
| | - Patricia McGettigan
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Daniel R Morales
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
- Division of Population Health Sciences, University of Dundee, Dundee, UK
| | - Jim Slattery
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
| | - Dagmar Vogl
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
| | - Thomas Goedecke
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
| | - Xavier Kurz
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
| | - Alison Cave
- Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
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Moulis G, Ibañez B, Palmaro A, Aizpuru F, Millan E, Lapeyre-Mestre M, Sailler L, Cambra K. Cross-national health care database utilization between Spain and France: results from the EPICHRONIC study assessing the prevalence of type 2 diabetes mellitus. Clin Epidemiol 2018; 10:863-874. [PMID: 30100760 PMCID: PMC6067780 DOI: 10.2147/clep.s151890] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
AIM The EPICHRONIC (EPIdemiology of CHRONIC diseases) project investigated the possibility of developing common procedures for French and Spanish electronic health care databases to enable large-scale pharmacoepidemiological studies on chronic diseases. A feasibility study assessed the prevalence of type 2 diabetes mellitus (T2DM) in Navarre and the Basque Country (Spain) and the Midi-Pyrénées region (France). PATIENTS AND METHODS We described and compared database structures and the availability of hospital, outpatient, and drug-dispensing data from 5.9 million inhabitants. Due to differences in database structures and recorded data, we could not develop a common procedure to estimate T2DM prevalence, but identified an algorithm specific to each database. Patients were identified using primary care diagnosis codes previously validated in Spanish databases and a combination of primary care diagnosis codes, hospital diagnosis codes, and data on exposure to oral antidiabetic drugs from the French database. RESULTS Spanish and French databases (the latter termed Système National d'Information Inter-Régimes de l'Assurance Maladie [SNIIRAM]) included demographic, primary care diagnoses, hospital diagnoses, and outpatient drug-dispensing data. Diagnoses were encoded using the International Classification of Primary Care (version 2) and the International Classification of Diseases, version 9 and version 10 (ICD-9 and ICD-10) in the Spanish databases, whereas the SNIIRAM contained ICD-10 codes. All data were anonymized before transferring to researchers. T2DM prevalence in the population over 20 years was estimated to be 6.6-7.0% in the Spanish regions and 6.3% in the Midi-Pyrénées region with ~2% higher estimates for males in the three regions. CONCLUSION Tailored procedures can be designed to estimate the prevalence of T2DM in population-based studies from Spanish and French electronic health care records.
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Affiliation(s)
- Guillaume Moulis
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France,
- UMR1027 INSERM, University of Toulouse, Toulouse, France,
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France,
| | - Berta Ibañez
- Navarrabiomed, Health Department, Public University of Navarra, Pamplona, Spain
- IdiSNA, Pamplona, Spain
- Health Service Research on Chronic Patients Network (REDISSEC), Pamplona, Spain
| | - Aurore Palmaro
- UMR1027 INSERM, University of Toulouse, Toulouse, France,
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France,
| | - Felipe Aizpuru
- Health Service Research on Chronic Patients Network (REDISSEC), Pamplona, Spain
- Research Unit Araba (BioAraba), Osakidetza-Basque Health Department, Vitoria-Gasteiz, Spain
- Healthcare Services Sub-directorate, Osakidetza-Basque Health Service, Araba, Spain
| | - Eduardo Millan
- Health Service Research on Chronic Patients Network (REDISSEC), Pamplona, Spain
- Healthcare Services Sub-directorate, Osakidetza-Basque Health Service, Araba, Spain
| | - Maryse Lapeyre-Mestre
- UMR1027 INSERM, University of Toulouse, Toulouse, France,
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France,
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Laurent Sailler
- Department of Internal Medicine, Toulouse University Hospital, Toulouse, France,
- UMR1027 INSERM, University of Toulouse, Toulouse, France,
- Clinical Investigation Center 1436, Toulouse University Hospital, Toulouse, France,
| | - Koldo Cambra
- IdiSNA, Pamplona, Spain
- Health Service Research on Chronic Patients Network (REDISSEC), Pamplona, Spain
- Institute of Public Health and Labour Health of Navarra, Pamplona, Spain
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Burgun A, Bernal-Delgado E, Kuchinke W, van Staa T, Cunningham J, Lettieri E, Mazzali C, Oksen D, Estupiñan F, Barone A, Chène G. Health Data for Public Health: Towards New Ways of Combining Data Sources to Support Research Efforts in Europe. Yearb Med Inform 2017; 26:235-240. [PMID: 29063571 PMCID: PMC6239221 DOI: 10.15265/iy-2017-034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Indexed: 12/21/2022] Open
Abstract
Objectives: To present the European landscape regarding the re-use of health administrative data for research. Methods: We present some collaborative projects and solutions that have been developed by Nordic countries, Italy, Spain, France, Germany, and the UK, to facilitate access to their health data for research purposes. Results: Research in public health is transitioning from siloed systems to more accessible and re-usable data resources. Following the example of the Nordic countries, several European countries aim at facilitating the re-use of their health administrative databases for research purposes. However, the ecosystem is still a complex patchwork, with different rules, policies, and processes for data provision. Conclusion: The challenges are such that with the abundance of health administrative data, only a European, overarching public health research infrastructure, is able to efficiently facilitate access to this data and accelerate research based on these highly valuable resources.
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Affiliation(s)
- A. Burgun
- Inserm, UMR 1138, Centre de Recherche des Cordeliers, AP-HP, Paris Descartes University, Paris, France
| | - E. Bernal-Delgado
- Institute for Health Sciences in Aragon (IACS), BridgeHealth Consortium, Zaragoza, Spain
| | - W. Kuchinke
- University of Dusseldorf, Dusseldorf, Germany
| | - T. van Staa
- Health eResearch Centre, Farr Institute, University of Manchester, Manchester, United Kingdom
| | - J. Cunningham
- Health eResearch Centre, Farr Institute, University of Manchester, Manchester, United Kingdom
| | | | | | - D. Oksen
- Public Health Institute, Inserm, AVIESAN, Paris, France
| | - F. Estupiñan
- Institute for Health Sciences in Aragon (IACS), BridgeHealth Consortium, Zaragoza, Spain
| | - A. Barone
- Lombardia Informatica, Milano, Italy
| | - G. Chène
- Inserm, UMR 1219, CIC1401-EC, Univ. Bordeaux, ISPED, CHU Bordeaux, Bordeaux, France
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Mayer F, Faglioni L, Agabiti N, Fenu S, Buccisano F, Latagliata R, Ricci R, Spiriti MAA, Tatarelli C, Breccia M, Cimino G, Fianchi L, Criscuolo M, Gumenyuk S, Mancini S, Maurillo L, Nobile C, Niscola P, Piccioni AL, Tafuri A, Trapè G, Andriani A, De Fabritiis P, Voso MT, Davoli M, Zini G. A Population-Based Study on Myelodysplastic Syndromes in the Lazio Region (Italy), Medical Miscoding and 11-Year Mortality Follow-Up: the Gruppo Romano-Laziale Mielodisplasie Experience of Retrospective Multicentric Registry. Mediterr J Hematol Infect Dis 2017; 9:e2017046. [PMID: 28698789 PMCID: PMC5499502 DOI: 10.4084/mjhid.2017.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/05/2017] [Indexed: 01/25/2023] Open
Abstract
Data on Myelodysplastic Syndromes (MDS) are difficult to collect by cancer registries because of the lack of reporting and the use of different classifications of the disease. In the Lazio Region, data from patients with a confirmed diagnosis of MDS, treated by a hematology center, have been collected since 2002 by the Gruppo Romano-Laziale Mielodisplasie (GROM-L) registry, the second MDS registry existing in Italy. This study aimed at evaluating MDS medical miscoding during hospitalizations, and patients' survival. For these purposes, we selected 644 MDS patients enrolled in the GROM-L registry. This cohort was linked with two regional health information systems: the Hospital Information System (HIS) and the Mortality Information System (MIS) in the 2002-2012 period. Of the 442 patients who were hospitalized at least once during the study period, 92% had up to 12 hospitalizations. 28.5% of patients had no hospitalization episodes scored like MDS, code 238.7 of the International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM). The rate of death during a median follow-up of 46 months (range 0.9-130) was 45.5%. Acute myeloid leukemia (AML) was the first cause of mortality, interestingly a relevant portion of deaths is due to cerebro-cardiovascular events and second tumors. This study highlights that MDS diagnosis and treatment, which require considerable healthcare resources, tend to be under-documented in the HIS archive. Thus we need to improve the HIS to better identify information on MDS hospitalizations and outcome. Moreover, we underline the importance of comorbidity in MDS patients' survival.
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Affiliation(s)
- Flavia Mayer
- Department of Epidemiology, Lazio Regional Health Service(Italy)
| | - Laura Faglioni
- Hematology Dep. Az. Osp. San Giovanni-Addolorata Rome(Italy)
| | - Nera Agabiti
- Department of Epidemiology, Lazio Regional Health Service(Italy)
| | - Susanna Fenu
- Hematology Dep. Az. Osp. San Giovanni-Addolorata Rome(Italy)
| | | | - Roberto Latagliata
- Dep of Cellular Biotechnology and Hematology, University “La Sapienza” Rome (Italy)
| | - Roberto Ricci
- Dep of Cellular Biotechnology and Hematology, University “La Sapienza” Rome (Italy)
| | | | | | - Massimo Breccia
- Dep of Cellular Biotechnology and Hematology, University “La Sapienza” Rome (Italy)
| | - Giuseppe Cimino
- Dep. of Cellular Biotechnology and Hematology, University of Rome “Sapienza”–Polo Pontino, Latina(Italy)
| | - Luana Fianchi
- Hematology Institute Università Cattolica del Sacro Cuore Rome (Italy)
| | | | - Svitlana Gumenyuk
- Hematology and Stem Cell Transplantation Unit, Regina Elena National Cancer Institute Rome (Italy)
| | - Stefano Mancini
- Hematology Unit Az. Osp. San Camillo-Forlanini, Rome (Italy)
| | | | | | | | | | - Agostino Tafuri
- Hematology Unit Sant’ Andrea Univ. “La Sapienza “ Rome (Italy)
| | - Giulio Trapè
- Hematology Unit Az. Osp. Belcolle Viterbo (Italy)
| | | | | | | | - Marina Davoli
- Department of Epidemiology, Lazio Regional Health Service(Italy)
| | - Gina Zini
- Hematology Institute Università Cattolica del Sacro Cuore Rome (Italy)
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