Abstract
BackgroundThyroid cancer incidence is increasing in the United States (US) and many other countries. The objective of this study was to develop and evaluate algorithms using administrative medical claims data for identification of incident thyroid cancer.MethodsThis effort was part of a prospective cohort study of adults initiating therapy on antidiabetic drugs and used administrative data from a large commercial health insurer in the US. Patients had at least 6 months of continuous enrollment prior to initiation during 2009–2013, with follow-up through March, 2014 or until disenrollment. Potential incident thyroid cancers were identified using International Classification of Diseases, 9th Revision (ICD-9) diagnosis code 193 (malignant neoplasm of the thyroid gland). Medical records were adjudicated by a thyroid cancer specialist. Several clinical variables (e.g., hospitalization, treatments) were considered as predictors of case status. Positive predictive values (PPVs) and 95% confidence intervals (CIs) were calculated to evaluate the performance of two primary algorithms.ResultsCharts were requested for 170 patients, 150 (88%) were received and 141 (80%) had sufficient information to adjudicate. Of the 141 potential cases identified using ≥1 ICD-9 diagnosis code 193, 72 were confirmed as incident thyroid cancer (PPV of 51% (95% CI 43–60%)). Adding the requirement for thyroid surgery increased the PPV to 68% (95% CI 58-77%); including the presence of other therapies (chemotherapy, radio-iodine therapy) had no impact. When cases were required to have thyroid surgery during follow-up and ≥2 ICD-9 193 codes within 90 days of this surgery, the PPV was 91% (95% CI 81-96%); 62 (82%) of the true cases were identified and 63 (91%) of the non-cases were removed from consideration by the algorithm as potential cases.ConclusionsThese findings suggest a significant degree of misclassification results from relying only on ICD-9 diagnosis codes to detect thyroid cancer. An administrative claims-based algorithm was developed that performed well to identify true incident thyroid cancer cases.
Highlights
Thyroid cancer incidence is increasing in the United States (US) and many other countries
The primary objective of this study was to develop an algorithm for identifying true incident cases of thyroid cancer (TC) using clinical input on TC diagnosis and treatment working with a TC specialist (DR) and chronological listings of all claims for individual patients for a specified period of time
Claims profile review was completed on 211 patients, 41 of whom were dropped because their International Classification of Diseases (ICD)-9 193 codes were associated only with labs or because they had a pattern of care indicating a history of TC prior to cohort entry
Summary
Thyroid cancer incidence is increasing in the United States (US) and many other countries. The objective of this study was to develop and evaluate algorithms using administrative medical claims data for identification of incident thyroid cancer. Large administrative healthcare claims databases have been extremely valuable for the efficient and accurate examination of many health outcomes, including cancers. They can be used by providers, policy-makers, and researchers to monitor clinical activities, to increase our understanding of the risk factors associated with cancers, and to assess trends in occurrence. Algorithms that accurately identify cancer outcomes have been developed for a number of cancer types by combining multiple variables available in claims data (e.g., risk factors, diagnosis/procedure codes, timing patterns) [3,4,5].
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