Identifying cancer drug regimens in French health insurance database: An application in multiple myeloma patients.

Abstract

There is no consensus on how to handle complex drug combinations of cancer drugs through medico-administrative databases. Our objective was to develop an algorithm for identifying the nature and patterns of treatment lines in a cohort of newly treated multiple myeloma patients. A cohort of multiple myeloma patients starting a first treatment line was built using both ambulatory and hospital data from regional data of the French national healthcare system database (SNIIRAM). Patients were identified from January 2011 to September 2013 using ICD-10 codes for multiple myeloma ('C90') within long-term conditions or diagnosis from hospital data. Drugs of interest for cycle identification included bortezomib, imids (thalidomide, lenalidomide), alkylating drugs (cyclophosphamide, melphalan, bendamustine, doxorubicin) and dexamethasone. An algorithm was applied to define combinations of treatment received in the first 6months of treatment. Among the 236 patients included, 45% received bortezomib-melphalan-prednisone (VMP: n=107), 22% bortezomib-thalidomide-dexamethasone (VTD/VTD-PACE: n=52) and 21% melphalan-prednisone-thalidomide (MPT: n=49). Other drug regimens consisted in melphalan-prednisone (MP: 7%, n=17), lenalidomide-dexamethasone (RD) (4%, n=9), bortezomib-cyclophosphamide-dexamethasone (VCD: n=1) and bortezomib-bendamustine-dexamethasone (VBD: n=1). Type of drug regimens and allocation by age class (±65years) were in accordance with current recommendations. This study demonstrates the feasibility of identifying complex drug regimens in onco-haematology, using both outpatient and inpatient drug records in French health insurance databases.