Derivation and preliminary validation of an administrative claims-based algorithm for the effectiveness of medications for rheumatoid arthritis

Arthritis Research & Therapy

Jeffrey R Curtis²  John W Baddley⁴  Shuo Yang²  Nivedita Patkar²  Lang Chen²  Elizabeth Delzell²  Ted R Mikuls³  Kenneth G Saag²  Jasvinder Singh⁴  Monika Safford²  Grant W Cannon¹ 

[1] Division of Rheumatology, University of Utah, 30 North 1900 East, SOM4B200, Salt Lake City, UT 84132, USA

[2] Department of Medicine, University of Alabama, 510 20th Street South, FOT 805D, Birmingham, AL 35294, USA

[3] Division of Rheumatology, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE 68198, USA

[4] Department of Medicine, Birmingham VA Medical Center, 700 19th Street South, Birmingham, AL 35233, USA

关键词: biologic;    administrative claims data;    comparative effectiveness;    rheumatoid arthritis;   

Others  :  1098511
DOI  :  10.1186/ar3471

 received in 2011-03-22, accepted in 2011-09-20,  发布年份 2011

【 摘 要 】

Introduction

Administrative claims data have not commonly been used to study the clinical effectiveness of medications for rheumatoid arthritis (RA) because of the lack of a validated algorithm for this outcome. We created and tested a claims-based algorithm to serve as a proxy for the clinical effectiveness of RA medications.

Methods

We linked Veterans Health Administration (VHA) medical and pharmacy claims for RA patients participating in the longitudinal Department of Veterans Affairs (VA) RA registry (VARA). Among individuals for whom treatment with a new biologic agent or nonbiologic disease-modifying agent in rheumatic disease (DMARD) was being initiated and with registry follow-up at 1 year, VARA and administrative data were used to create a gold standard for the claims-based effectiveness algorithm. The gold standard outcome was low disease activity (LDA) (Disease Activity Score using 28 joint counts (DAS28) ≤ 3.2) or improvement in DAS28 by > 1.2 units at 12 ± 2 months, with high adherence to therapy. The claims-based effectiveness algorithm incorporated biologic dose escalation or switching, addition of new disease-modifying agents, increase in oral glucocorticoid use and dose as well as parenteral glucocorticoid injections.

Results

Among 1,397 patients, we identified 305 eligible biologic or DMARD treatment episodes in 269 unique individuals. The patients were primarily men (94%) with a mean (± SD) age of 62 ± 10 years. At 1 year, 27% of treatment episodes achieved the effectiveness gold standard. The performance characteristics of the effectiveness algorithm were as follows: positive predictive value, 76% (95% confidence interval (95% CI) = 71% to 81%); negative predictive value, 90% (95% CI = 88% to 92%); sensitivity, 72% (95% CI = 67% to 77%); and specificity, 91% (95% CI = 89% to 93%).

Conclusions

Administrative claims data may be useful in evaluating the effectiveness of medications for RA. Further validation of this effectiveness algorithm will be useful in assessing its generalizability and performance in other populations.

【 授权许可】

   
2011 Curtis et al.; licensee BioMed Central Ltd.

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