Validation of an algorithm identifying incident primary immune thrombocytopenia in the French national health insurance database

Mezaache, Salim; Derumeaux, Hélène; Ferraro, Pierre; Capdepon, Pascal; Steinbach, Jean-Christophe; Abballe, Xavier; Palas, Deborah; Saichi, Nabil; Desboeuf, Karine; Lapeyre‐Mestre, Maryse; Sailler, L.; Moulis, Guillaume

doi:10.1111/ejh.12926

Cited by 19 publications

(9 citation statements)

References 14 publications

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“…Most notably, a validated (and sufficiently sensitive/specific) algorithm for identifying ITP in healthcare claims data is-to the best of our knowledge-not available from published literature. We therefore employed an operational algorithm for ITP that we believe is clinically reasonable and consistent with approaches used in other retrospective evaluations [24][25][26] . We note, however, that our algorithm has not been formally validated against a 'gold-standard' and thus its accuracy is unknown.…”

Section: Discussionmentioning

confidence: 99%

Primary immune thrombocytopenia in US clinical practice: incidence and healthcare burden in first 12 months following diagnosis

Weycker

Hanau

Hatfield

et al. 2019

Journal of Medical Economics

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Introduction: Primary immune thrombocytopenia (ITP), an autoimmune disorder characterized by low platelet count, can lead to serious bleeding events. Little is known about the current epidemiology of ITP in the US, and even less is known about the current healthcare burden of ITP, especially in the 12-month period following ITP diagnosis. Method: We used a retrospective cohort design and data from two US private healthcare claims databases (2010)(2011)(2012)(2013)(2014)(2015)(2016) to identify persons with evidence of newly diagnosed ITP. We weighted estimates of the annual incidence of ITP by age and sex to reflect the US population, and summarized healthcare utilization and expenditures (2016 US$) during the first 12 months after ITP diagnosis ("followup period"). Results: Annual incidence of ITP in the US was 6.1 per 100,000 persons, higher among females versus males (6.7 vs. 5.5), and highest among children aged 0-4 years (8.1) and adults aged !65 years (13.7). Patients with ITP averaged 0.33 (95% CI: 0.32-0.35) hospitalizations and 15.3 (15.1-15.6) ambulatory encounters during the follow-up period; mean total healthcare expenditures during this period were $21,290 (20,502-22,031). Hospitalizations were more common during the first 3 months following diagnosis, and were twice as frequent among children versus adults; expenditures for ambulatory encounters were substantially higher for adults versus children aged 0-4 years. Conclusions: Our findings suggest that nearly 20,000 children and adults are newly diagnosed with ITP each year in the US, substantially higher than previously reported. Among patients requiring formal medical care, the economic burden during the first 12 months following diagnosis is high, with estimated US expenditures totaling over $400 million.

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Section: Discussionmentioning

confidence: 99%

Primary immune thrombocytopenia in US clinical practice: incidence and healthcare burden in first 12 months following diagnosis

Weycker

Hanau

Hatfield

et al. 2019

Journal of Medical Economics

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“…This population‐based retrospective cohort study with longitudinal follow‐up was conducted from January 1, 2006, to December 31, 2013. This study used a method modified from a previous study to identify incident ITP from the French national health insurance database; this method was validated in another report showing a positive predictive value of 83.2% (95% confidence interval [CI], 77.4%‐89.0%) for incident ITP . Figure shows the patient selection algorithm.…”

Section: Methodsmentioning

confidence: 99%

“…This study used a method modified from a previous study to identify incident ITP from the French national health insurance database 2 ; this method was validated in another report showing a positive predictive value of 83.2% (95% confidence interval [CI], 77.4%-89.0%) for incident ITP. 17 Figure 1 shows the patient selection algorithm. First, patients with any medical visit encoded as ITP (ICD-9-CM codes starting with 287.3) during the study period were extracted from the NHIRD (N = 21,354).…”

Section: Patient Identificationmentioning

confidence: 99%

Incidence of immune thrombocytopenia in Taiwan: a nationwide population‐based study

et al. 2018

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BACKGROUND The incidence of immune thrombocytopenia (ITP) is not well known in Asians. The aims of this study were to survey incidences and clinical features of ITP in Taiwan. STUDY DESIGN AND METHODS This study identified 4855 incident ITP cases from the population‐based National Health Insurance Research Database from mid‐2006 to mid‐2013, and compared incidences, patient characteristics, and clinical manifestations of ITP by age. RESULTS Respective ITP incidence rates among those aged <15, 15 to 59, and ≥60 years were 4.0, 2.0, and 5.4 per 100,000 person‐years. A male predominance was noted in children, and a female predominance was found in adults. The most common causes of secondary ITP were systemic lupus erythematosus (21.8%), viral hepatitis C (16.9%), and viral hepatitis B (13.4%). The rate of secondary ITP in children was less than one fifth that in adults (4.2% vs. 23.8%). Rates of central nervous system (1.1%) and gastrointestinal tract bleeding (3.3%) were rare, with variations by age. The rate of splenectomies in children (0.4%) was only one tenth that in adults (4.1%). The disease in 25% of children and 30% of adults became persistent or chronic. A decreasing trend in the ITP incidence was found (annual percentage change, −4.9%), and it was confined to those aged >15 years. CONCLUSION Incidence estimates of ITP in Taiwan were close to those of Western countries, with age‐specific variations in sex ratio, comorbidity, splenectomy, secondary causes, and incidence trends. The results suggest no racial variations in ITP incidences, but a geographical difference in causes of secondary ITP.

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“…extracted from local hospital databasesbefore their de-identification and integration to the SNDSwith traditional sources of information such as medical charts or registries, and leading to a PPV varying from 80 to 90% but tending to decrease according to the granularity of the required information[21][22][23][24][25][26][27].…”

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confidence: 99%

Intra-database Validation of Case-identifying Algorithms Using Reconstituted Electronic Health Records From Healthcare Claims Data

Thurin

Bosco‐Lévy

Blin

et al. 2021

Preprint

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Background: Diagnosis performances of case-identifying algorithms developed in healthcare database are usually assessed by comparing identified cases with an external data source. When this is not feasible, intra-database validation can present an appropriate alternative.Objectives: To illustrate through two practical examples how to perform intra-database validations of case-identifying algorithms using reconstituted Electronic Health Records (rEHRs).Methods: Patients with 1) multiple sclerosis (MS) relapses and 2) metastatic castration-resistant prostate cancer (mCRPC) were identified in the French nationwide healthcare database (SNDS) using two case-identifying algorithms. A validation study was then conduct to estimate diagnostic performances of these algorithms through the calculation of their positive predictive value (PPV) and negative predictive value (NPV). To that end, anonymized rEHRs were generated based on the overall information captured in the SNDS over time (e.g. procedure, hospital stays, drug dispensing, medical visits) for a random selection of patients identified as cases or non-cases according to the predefined algorithms. For each diseases, an independent validation committee reviewed the rEHRs of 100 cases and 100 non-cases in order to adjudicate on the status of the selected patients (true case/ true non-case), blinded with respect to the result of the corresponding algorithm. Results: Algorithm for relapses identification in MS showed a 95% PPV and 100% NPV and for mCRPC identification, a 97% PPV and 99% NPV. Conclusion: The use of rEHRs to conduct an intra-database validation appears to be a valuable tool to estimate the performances of a case-identifying algorithm and assess its validity, in the absence of alternative.

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Validation of an algorithm identifying incident primary immune thrombocytopenia in the French national health insurance database

Abstract: This study showed a very good PPV of this algorithm identifying incident primary ITP patients in the SNIIRAM.

Cited by 19 publications

References 14 publications

Primary immune thrombocytopenia in US clinical practice: incidence and healthcare burden in first 12 months following diagnosis

Primary immune thrombocytopenia in US clinical practice: incidence and healthcare burden in first 12 months following diagnosis

Incidence of immune thrombocytopenia in Taiwan: a nationwide population‐based study

Intra-database Validation of Case-identifying Algorithms Using Reconstituted Electronic Health Records From Healthcare Claims Data

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