Claims Data Research Articles

Association of Ruxolitinib Cream Initiation With Continued Reduction in Use of Other Topical Treatments, Oral Corticosteroids, and Biologics for Atopic Dermatitis

The objective of this analysis was to examine the impact of ruxolitinib cream on the use of other treatments for atopic dermatitis (AD). This study used claims data from the Healthcare Integrated Research Database (HIRD®) to identify new users of ruxolitinib cream from October 1, 2021, to March 31, 2022. The index date was the date of the first claim for ruxolitinib cream. The baseline period was the 6-month period before the index date, and the follow-up period was 12 months after the index date, which was divided into months 1–6 and months 7–12. Use of other topical and systemic therapies for AD were descriptively analyzed. Among 556 ruxolitinib cream users with follow-up data, the mean number of ruxolitinib cream fills in the overall 12-month follow-up period was 2.1 (SD, 1.77; range, 1–12). The mean (SD) patient age was 40.3 (17.32) years. In months 1–6 and 7–12, 39.9% and 37.4% of patients were treated with ruxolitinib cream monotherapy, respectively; 72.5% and 73.9% of patients did not receive a new class of AD treatment during the respective follow-up periods. Topical corticosteroid use in patients was reduced from 53.4% at baseline to 31.3% in months 1–6 and 26.6% in months 7–12. Topical calcineurin inhibitor use decreased from 14.9% at baseline to 5.2% in months 1–6 and 5.0% in months 7–12. Similarly, topical phosphodiesterase 4 inhibitor use decreased from 6.7% at baseline to 3.4% in months 1–6 and 1.6% in months 7–12. The mean cumulative prednisone-equivalent dose was also reduced from 83.9 mg during the baseline period to 58.0 mg for months 1–6 and 47.3 mg for months 7–12. For patients who did not receive AD biologic therapy during the baseline period (n=431), 92.3% in months 1–6 and 91.4% in months 7–12 continued to remain off AD biologic therapy. Among patients who received AD biologics at baseline (n=125), 16.0% did not receive them in months 1–6 and 26.4% did not receive them in months 7–12. In conclusion, following initiation of ruxolitinib cream, there was a continued reduction in use of other topical therapies and oral corticosteroids for AD. Most biologic-naive patients (>90%) avoided biologics in the 12 months following ruxolitinib cream initiation. Approximately 1 in 4 patients who had biologic treatment during baseline did not continue biologic use in months 7–12. This 12-month analysis confirms earlier 6-month findings that indicated treatment with ruxolitinib cream may reduce the use of other topical therapies, oral corticosteroids, and biologics in patients with AD. (Funding, Incyte Corporation)

Initiating continuous glucose monitoring is associated with improvements in glycemic control and reduced health care resource utilization for people with diabetes in a large US-insured population: A real-world evidence study.

To examine the real-world impact of continuous glucose monitoring (CGM) use on glycemic management and health care resource utilization (HCRU) in people with diabetes in a large US-insured population. This retrospective observational study used Aetna administrative claims data from a cohort of fully insured commercial and Medicare Advantage beneficiaries with diabetes and with coverage for medical and pharmacy benefits. The index date was the first CGM pharmacy or medical claim observed between January 1, 2019, and December 31, 2021. Change in hemoglobin A1c was calculated using values from 3 months before and the latest values 10-12 months after the index date. HCRU was measured 12 months before and after the index date. Data were analyzed by the following patient groups: type 1 diabetes, type 2 diabetes (T2D) on intensive insulin therapy, T2D on basal-only insulin therapy, and T2D not on insulin therapy. Data from 7,336 patients (74% T2D, mean age 57 years, 42% Medicare-insured, 54% male, 56% White) were analyzed. Beneficiaries with available A1c data (n = 1,063) showed a significant improvement in A1c after CGM initiation (-0.7%, P < 0.0001), including -0.9% change in the T2D not on insulin group (n = 264). For the overall cohort, the number of patients with diabetes-related hospitalizations and emergency department visits decreased significantly by 67% and 40%, respectively (P < 0.0001 for both). This study showed that CGM use was associated with clinically meaningful improvements in A1c and reduced HCRU, suggesting potential for population-level clinical benefits, especially for patients not using insulin.

Higher healthcare cost and utilization before and after diagnosis of AATD in the United States.

Patients with alpha-1 antitrypsin deficiency (AATD) often experience substantial delays from the onset of symptoms to a diagnosis. We explored the impact of delayed diagnosis of AATD on healthcare costs and utilization by assessing costs/utilization before and after diagnosis. Retrospective claims data was used to conduct a longitudinal analysis of a cohort of patients with follow-up over four years in a commercial claims database was conducted. Patients with at least four years of claims experience between the years 2011 - 2017 were included in this study. Outcome measures were calculated for each year (Year 1 pre-index diagnosis, and Years 1, 2, and 3 post-index follow-up). Measures included healthcare costs (pharmacy and medical costs), medical costs, inpatient events, and emergency room visits. Unadjusted measures in the follow-up Year 1, Year 2, and Year 3 were compared to Year 1 pre-index. A separate multivariate analysis adjusting for age, sex, and comorbidities was conducted. Among 1258 patients, mean adjusted healthcare costs were significantly higher in Year 1 post-index compared to Year 1 pre-index ($51,785 vs $41,441, p = < 0.05). In Year 2 ($36,937 vs $41,441, p = < 0.05) and 3 ($28,558 vs $41,441, p = < 0.05) post-index, mean adjusted healthcare costs decreased compared to Year 1 pre-index. Adjusted medical costs were similar in Year 1 ($25,034) post-index compared to Year 1 ($22,952) pre-index but were significantly lower in Year 2 ($15,242 vs $25,034, p = < 0.05) and Year 3 ($8,779 vs $25,034, p = < 0.05) post-index. The frequency of inpatient and emergency room events was significantly lower in all three observation periods following diagnosis in the unadjusted analysis. The adjusted analysis showed similar findings, except for emergency room visits, which were similar across all observation periods. Patients with AATD had substantial healthcare costs/utilization in the year before diagnosis. Costs were significantly higher in the first year following diagnosis. However, subsequent years showed cost reductions to levels below pre-diagnosis. These data support the need for strategies to reduce the time from symptom onset to diagnosis.

The Incidence and Risk Factors of Persistent Opioid Use After Surgery—a Retrospective Secondary Data Analysis.

The risk of persistent postoperative opioid use (PPOU) and its association with the type of surgery are still unclear in Germany. We conducted a nationwide retrospective cohort study on the basis of claims data from BARMER, a statutory health insurance carrier in Germany. Opioid-naive adults who did not have cancer and who underwent inpatient surgery in 2018 were included in the study. The operations were divided into 103 categories. PPOU was defined as the prescribing of opioids between postoperative days 1 and 90 and also between postoperative days 91 and 180 after hospital discharge. Patient-associated risk factors in the 12 months before surgery were investigated. 203 327 patients were included. 1.4% had PPOU (95% confidence interval [1.4; 1.5]). There were major differences between operation groups: major amputations and orthopedic procedures carried the greatest risk for the development of PPOU. The type of surgery had a larger effect on the risk of PPOU than pre-existing risk factors (explained variance 22.3% vs. 14.3%). Among such factors, alcohol abuse and pre-existing treatment with antidepressant drugs were associated with the highest risk for PPOU (odds ratios [OR] 1.515 [1.277; 1.797] and 2.131 [1.943; 2.336]). The incidence of PPOU in Germany is low (1.4%). The type of surgery plays an important role in its development.

Age differences in the treatment of lung cancer-a cohort study among 42,000 patients from Germany.

We aimed to describe treatment of lung cancer patients in Germany based on health claims data, focusing particularly on differences by age. Using the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population) we identified lung cancer patients diagnosed in 2015-2018 based on a previously developed algorithm and followed them until death, end of continuous insurance or end of 2020. We described initial treatment patterns after diagnosis and survival, stratified among others by age. We included 42,629 incident lung cancer patients (58% male). Surgery within three months after diagnosis was performed in 36%, 31%, 29% and 18% of patients aged < 50, 50-69, 70-79 and ≥ 80, respectively. Among patients without surgery, systemic therapy was administered in 77%, 72%, 54% and 25% of patients aged < 50, 50-69, 70-79 and ≥ 80, respectively. Monoclonal antibodies were administered in 15-30% of patients across age groups, and 4% to 15% received protein kinase inhibitors. Overall, 21% of patients remained untreated. In the age groups < 50, 50-69, 70-79 and ≥ 80, this proportions was 9%, 12%, 22% and 48%, respectively. In conclusion, our study provides a comprehensive overview of the therapy of lung cancer patients in Germany and quantitatively demonstrates the considerable differences between age groups. In terms of clinical cancer registration, the results are useful to estimate the completeness of data for the different types of treatment.

Effect of choline alfoscerate in older adult patients with dementia: an observational study from the claims data of national health insurance.

Choline alfoscerate, a cholinergic precursor with limited evidence of efficacy in dementia management, has been used for various cognitive impairments in Korea. Partly due to its insurance coverage, this agent appears to incur significant expense for the insurance system. Thus, we aimed to describe choline alfoscerate prescription patterns and analyze their long-term effects in an older adult cohort with dementia. This observational study used the National Health Insurance Service Senior Cohort Dataset. Choline alfoscerate -naïve patients who were diagnosed with dementia between 2003 and 2014 with at least 12 months of follow-up were selected. Time-dependent Cox regression was employed to estimate the association between drug exposure and the risk of treatment failure events. There were 11,463 eligible participants, of whom approximately 73% were female, and 19% had been exposed to choline alfoscerate. According to the main regression survival analysis, the association between longitudinal choline alfoscerate use and the risk of progression events related to treatment failure was unclear. However, a significant decrease of nearly 20% in the risk of all-cause mortality was associated with choline alfoscerate exposure, and a slight reduction in progression regarding treatment failure was observed with CA use only during the early stages of diagnosis. Age, sex, insurance premiums, several comorbidities and concurrent medications were significantly associated with the probability of the events according to the multivariate models. Further analyses are needed to confirm the early-stage and long-term effectiveness of choline alfoscerate in specific populations, which will help in considering its reimbursement.

Effect of an Intensive Nurse Home Visiting Program on Postpartum Contraceptive Use and Birth Spacing

OBJECTIVE: To evaluate the effect of an intensive nurse home visiting program on postpartum contraceptive use and birth spacing among individuals with a first pregnancy who were eligible for Medicaid insurance in South Carolina. METHODS: We conducted a nonblinded, randomized controlled trial of the Nurse-Family Partnership (NFP), an established intensive home visiting program that provides prenatal and postpartum home visits through 2 years after childbirth. The trial included patients who were eligible for Medicaid insurance with a first pregnancy at less than 28 weeks of gestation between April 1, 2016, and March 17, 2020, who were followed up through 2 years after childbirth. Participants were randomized 2:1 to NFP compared with standard of care treatment. The primary outcome was a birth interval of less than 21 months between the index pregnancy and a subsequent birth. The secondary outcomes were birth intervals of less than 15 and 24 months, receipt of a contraceptive implant or intrauterine device (IUD) immediately postpartum, any contraceptive use and receipt of a family planning visit (at both 6 weeks and 1 year postpartum), and IUD receipt at 1 year postpartum. We assessed outcomes using linked birth certificate records and Medicaid claims data. RESULTS: A total of 4,932 trial participants (3,295 in the intervention group and 1,637 in the control group) were included in the study analysis. Within 21 months of the study index birth, 11.0% of individuals in the NFP group and 12.2% of the usual care group had a subsequent birth. The NFP did not have a statistically significant effect on birth intervals of less than 21 months (adjusted coefficient −1.1, 95% CI, −2.9 to 0.8). There were no statistically significant differences between the NFP and control groups for any of the study's eight secondary outcomes related to birth spacing and postpartum contraceptive use. CONCLUSION: Home visits with a registered nurse did not affect postpartum contraceptive use or birth spacing. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03360539.

Impact of the COVID-19 pandemic on incidence of coronary heart disease in Bavaria, Germany: an analysis of health claims data

BackgroundInconsistent findings about the impact of the COVID-19 pandemic on cardiovascular disease diagnosis and consultations have been reported internationally. The objective of this study was to analyse the impact of...

Real-world mepolizumab treatment in eosinophilic granulomatosis with polyangiitis reduces disease burden in the United States.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare, chronic inflammatory disease characterized by asthma and small/medium vessel vasculitis. Mepolizumab is approved for use in EGPA disease management alongside oral corticosteroids (OCS), but evidence of its real-world impact is limited. To compare real-world treatment patterns and health outcomes, particularly OCS use, EGPA-related hospitalizations/relapses, and asthma exacerbations pre- and post-mepolizumab initiation in US patients with EGPA. Patients with EGPA receiving ≥2 mepolizumab doses were identified using administrative claims data from Komodo Health's Comprehensive Dataset (December 2016-March 2020). Outcomes assessed pre- and post-mepolizumab initiation included corticosteroid/other medication use, EGPA-related hospitalizations/relapses, and asthma exacerbations. Overall, 114 patients were identified; of these, 60 (53%) received mepolizumab 300 mg at index. Average daily OCS dose per dispensing was significantly lower post- versus pre-mepolizumab initiation (21.2 vs 26.8 mg/day, 21% relative reduction, P<0.001); mean number of OCS bursts also decreased (0.9 vs 1.8, 50% relative reduction, P<0.001). Patients experienced significantly lower rates of EGPA-related hospitalization (0.86 vs 1.55 per person-year [PPY], 49% relative reduction, P=0.004) and EGPA relapse (3.18 vs 3.94 PPY, 19% relative reduction, P=0.004) post- versus pre-initiation. Most patients (91%) had an asthma diagnosis at baseline; among these patients, asthma exacerbation rates were significantly lower post- versus pre-initiation (1.05 vs 1.84 PPY, 42% relative reduction, P=0.004). Mepolizumab was associated with significant steroid-sparing benefits and significantly reduced rates of EGPA-related hospitalizations, EGPA relapses, and asthma exacerbations in this real-world study of US patients with EGPA, confirming the benefits of mepolizumab treatment seen in clinical trials.

Vaccination as a risk factor for pediatric multiple sclerosis: Insights from a retrospective case-control study.

This study evaluated the association between pediatric multiple sclerosis and vaccinations within 5 years before diagnosis using German ambulatory claims data. Children with multiple sclerosis (n = 346) aged 9-17 were analyzed with logistic and Poisson regression. Control groups included children with Crohn's disease, psoriasis, and no autoimmune diseases. The results indicated a negative association between vaccinations and pediatric multiple sclerosis, with no significant risk identified. This negative relationship was consistent in sensitivity and clinically isolated syndrome analyses. Overall, the study's findings do not support the hypothesis that vaccination is a risk factor for pediatric multiple sclerosis.

Integrating electronic health records with other data sources for postmarket drug safety signal identification: a review

Electronic health records (EHRs) have emerged as resources for both the identification of adverse drug events (ADEs) and general population health surveillance, however questions remain around how best to utilize EHR data for drug safety signal identification. While the majority of signal identification research has utilized spontaneous reports and health insurance claims, these data also have limitations. Pharmacovigilance approaches combining EHR data with other data sources have the potential to address many of the shortcomings of individual sources. This mini-review seeks to provide an overview of some of the recent research leveraging EHR data in combination with spontaneous reports, claims data, and other pharmacovigilance data sources for drug safety signal identification. Studies have shown that combining EHR data with these and other sources is often beneficial compared to the use of a single source alone, however the synergism or friction introduced is insufficiently explored in current literature. Our review explores how EHR data benefits signal identification when used in combination with other sources, what methods have been applied, and what considerations have previously been noted. Finally, we identify gaps in current research and highlight important considerations for future work using multiple real world data sources for drug safety surveillance.

Incidence Trends of Rheumatoid Arthritis in Korea for 11 Years (2006–2017)

Background/Objectives: Rheumatoid arthritis (RA) is a chronic inflammatory disorder characterized by joint damage. However, no incidence analyses have been conducted on a Korean population since 2013. We aimed to calculate the incidence of RA and examine trends using complete Korean National Health Insurance Service claims data from 2007. Methods: We used 16 years of Korean NHIS claims data from 1 January 2002 to 31 December 2017. Patients were defined as having RA when diagnosed with ICD-10 codes M05 and M06. We set the 5-year period prior to 2006 as disease-free. Results: From 2007 to 2017, the incidence rate of RA was 35 to 43 per 100,000 individuals. The female-to-male ratio was approximately 3–3.5 to 1. The sex-standardized incidence rate was highest in the 60–69 age group but gradually declined, resulting in a reversal in 2017, with the highest incidence rate observed in the 50–59 age group. The incidence of elderly onset RA (EORA) in individuals aged &gt;60 years exhibited a decreasing trend during the study period (age 60–69, −6.45, 95% CI = −8.27 to −4.62, p &lt; 0.001; age ≥70, −6.09, 95% CI = −7.66 to −4.53, p &lt; 0.001). Conclusions: This study is the first to analyze the incidence trend of RA over an 11-year period. In South Korea, the incidence of RA has shown a decreasing trend since 2011; the same trend was observed in the EORA group. Young-onset RA showed the opposite trend, suggesting that RA is diagnosed earlier, due to the new RA classification criteria.

Accounting for Twins and Other Multiple Births in Perinatal Studies of Live Births Conducted Using Healthcare Administration Data

The analysis of perinatal studies is complicated by twins and other multiple births even when multiples are not the exposure, outcome, or a confounder of interest. In analyses of infant outcomes restricted to live births, common approaches to handling multiples include restriction to singletons, counting outcomes at the pregnancy-level (i.e., by counting if at least one twin experienced a binary outcome), or infant-level analysis including all infants and accounting for clustering of outcomes, such as by using generalized estimating equations or mixed effects models. Several healthcare administration databases only support restriction to singletons or pregnancy-level approaches. For example, in MarketScan insurance claims data, diagnoses in twins are often assigned to a single infant identifier, thereby preventing ascertainment of infant-level outcomes among multiples. Different approaches correspond to different questions, produce different estimands, and often rely on different assumptions. We demonstrate the differences that can arise from these different approaches using Monte Carlo simulations, algebraic formulas, and an applied example.

Changes in healthcare costs and utilization for Medicaid recipients who received supportive housing through a payer-community-based housing partnership.

To evaluate healthcare cost and utilization changes among Medicaid and dually eligible participants of a supportive housing program implemented by a managed care organization and community-based organization. Healthcare claims were reviewed retrospectively for 80 program participants in one urban Pennsylvania county between 1/1/2018 and 9/28/2023 who had ≥6 months of claims data in both pre- and post-housing periods. Eligibility included age >18 years, Medicaid/Special Needs Plan enrollment, and housing need. Due to limited housing units, potential participants were prioritized by medical need and history of unplanned care. Healthcare cost and utilization were compared during pre- (i.e., 12 months before housing initiation) and post-periods (i.e., 12 months after housing initiation). Compared to the pre-period, significantly lower medical (-40.4%, p = 0.004), emergency department (-62.7%, p = 0.02), and total (-33.3%, p = 0.02) costs of care were observed in the post-period. Significantly lower primary care (-50.0%, p = 0.0003), specialist (-31.3%, p = 0.02), and emergency department (-50.0%, p = 0.03) utilization were also observed. Healthcare cost and utilization among medically complex individuals were lower with supportive housing. Future evaluations with randomized designs can address the potential causal impact of supportive housing as a healthcare intervention on specific outcomes.

Postpartum Access to Health Care and Opioid Use Treatment: An Evaluation of a Medicaid Population

Background In this study, we aimed to examine postpartum health care utilization and identify gaps in care among a postpartum Medicaid population of patients diagnosed with opioid use disorder (OUD) during pregnancy. Methods We queried North Carolina Medicaid medical and pharmacy claims to identify individuals with a live delivery and evidence of OUD during pregnancy from 2015 to 2019. We examined any evidence of postpartum health care utilization and evidence of medications for OUD (MOUD) during postpartum. We also determined the impact that 4 factors may have had on these outcomes: type of Medicaid coverage (Medicaid for Pregnant Women as compared to other types of Medicaid coverage), rurality, race, and the prenatal use of MOUD. Descriptive statistics, Kaplan-Meier curves with log-rank tests, and negative binomial regression were used. Results Of the 6,186 individuals in the study, 84.5% were White, 29.6% lived in rural areas, and 35.0% had MPW coverage. Of the sample, 77.4% sought health care services during the postpartum period. In the multiple negative binomial regression model, individuals who were MPW beneficiaries, non-White, lived in rural areas, and had no evidence of prenatal MOUD all had significantly lower rates of postpartum health care utilization. Of the sample, 53.6% had evidence of MOUD utilization during the postpartum period. We found that patients with MPW continued MOUD at much lower rates compared to patients with other forms of Medicaid (86% versus 93% at 60 days; 57% versus 78% at 180 days, respectively). Limitations Limitations to this analysis are inherent to administrative claims data, such as misclassification of outcomes and covariates, as well as loss to follow-up. Conclusions Significant gaps in health care use remain across type of Medicaid coverage, race, geographic setting, and prenatal care access.

Demographics, comorbidities, and comedications in newly diagnosed patients with Alzheimer's disease and related dementias: Findings from United States Medicare claims data.

Medicare claims data enables broad characterization of United States (US) patients with Alzheimer's disease and related dementias (ADRD). Resulting insights can be used as a reference to describe this population and as a benchmark for generalizability of patients with ADRD enrolled in clinical trials. To characterize demographics, comorbidities, comedications, and healthcare resource utilization in US patients with newly diagnosed ADRD, focusing on differences across Medicare fee-for-service (FFS) and Medicare Advantage enrollees. This observational cohort study used complete (100%) Medicare claims data inclusive of both FFS and Medicare Advantage insurance types. Study patients were ≥65-years-old with ≥12 months of continuous pre-index enrollment and Medicare Part D coverage. Two cohorts of patients were selected in calendar year 2019; those newly diagnosed with ADRD and those with a new acetylcholinesterase inhibitor (AChEI) claim. The newly diagnosed ADRD and new AChEI users cohorts included 861,727 and 395,319 patients, respectively. Demographics and comedications were generally similar across the two cohorts, supporting internal validity of the study results. Circulatory system-related comorbidities and mood disorders were common in both cohorts. Differences in race, inpatient claims and long-term care claims were observed between insurance types. The study results provide a reference for describing the ADRD population in the US and emphasize the importance of evaluating new Alzheimer's disease drugs in broad patient populations with comorbidities and concomitant medication use.

Long-Term Outcomes of Component Separation for Abdominal Wall Hernia Repair.

Component separation is a reconstructive technique used to facilitate midline closure of large or complex ventral hernias. Despite a contemporary surge in popularity, the incidence and long-term outcomes after component separation remain unknown. To evaluate the incidence and long-term outcomes of component separation for abdominal wall hernia repair. This cohort study examined 100% Medicare administrative claims data from January 1, 2007, to December 31, 2021. Participants were adults (aged ≥18 years) who underwent elective inpatient ventral hernia repair. Data were analyzed from January through June 2024. Use of component separation technique during ventral hernia repair. The primary outcomes were the incidence of component separation over time and operative recurrence rates up to 10 years after surgery for hernia repairs with and without component separation. The secondary outcome was rate of operative recurrence after component separation stratified by surgeon volume. Among 218 518 patients who underwent ventral hernia repair, the mean (SD) age of the cohort was 69.1 (10.9) years; 127 857 patients (58.5%) were female and 90 661 (41.5%) male. A total of 23 768 individuals had component separation for their abdominal wall hernia repair. The median (IQR) follow-up time after the index hernia surgery was 7.2 (2.7-10) years. Compared with patients who did not have a component separation, patients undergoing repair with component separation were slightly younger; more likely to be male; and more likely to have comorbidities, including obesity, and had surgeries that were more likely to be performed open and use mesh. Proportional use of component separation increased from 1.6% of all inpatient hernia repairs in 2007 (279 patients) to 21.4% in 2021 (1569 patients). The 10-year adjusted operative recurrence rate after component separation was lower (11.2%; 95% CI, 11.0%-11.3%) when compared with hernia repairs performed without component separation (12.9%; 95% CI, 12.8%-13.0%; P = .003). Operative recurrence was lower for the top 5% of surgeons by component separation volume (11.9%; 95% CI, 11.8%-12.1%) as opposed to the bottom 95% of surgeons by volume (13.6%; 95% CI, 13.4%-13.7%; P = .004). This study found that component separation was associated with a protective effect on long-term operative recurrence after ventral hernia repair among Medicare beneficiaries, which is somewhat unexpected given the intent of its use for higher complexity hernias. Surgeon volume, while significant, had only a minor influence on operative recurrence rates.

Appropriate Allergic Rhinitis Medications Can Reduce Systemic Steroid Requirement and Prevent Rhinosinusitis

Background: Allergic rhinitis (AR) is quite common and sometimes it requires systemic steroids and can be accompanied by coronavirus disease-2019 (COVID-19), rhinosinusitis, or asthma. We aimed to determine the comparative effect of different types of AR medications on clinical prognosis in real-world settings. Methods: We used national claims data provided by the National Health Insurance Service in the Republic of Korea. We enrolled 275,895 adult patients who were first diagnosed with AR and started AR medications between 1 January 2018 and 31 December 2018. We classified them into five groups according to the type of AR medication prescribed and analyzed their 3-year follow-up data. Results: The prescription rate of systemic steroids was low in the INCS group (19%), whereas it was 35–40% in other groups. INCS users needed less systemic steroids than other AR medication users (hazard ratio [HR], 0.503; 95% confidence interval [CI], 0.452–0.560; p-value &lt; 0.001). The incidence of rhinosinusitis was approximately 11% in the other AR medication group and 6–8% in the other groups. AH (HR, 0.745; 95% CI, 0.616–0.903; p = 0.003), AH-LTRA (HR, 0.667; 95% CI, 0.551–0.808; p &lt; 0.001), and INCS (HR, 0.746, 95% CI, 0.615–0.904; p = 0.003) significantly prevent rhinosinusitis, compared with other AR medication. However, other prognosis factors were not significantly correlated with the type of AR medications. Conclusions: INCS can reduce systemic steroid requirements and AH, AH-LTRA, and INCS prevent rhinosinusitis compared with other AR medications. As choosing an appropriate AR medication can determine the clinical outcomes, clinicians should be careful in prescribing proper AR medications.

Abstract 4119094: Claims-Based versus Registry-Reported Stroke Events in the NCDR Left Atrial Appendage Occlusion Registry

Background: Administrative claims data are increasingly used for post-marketing surveillance of drugs and medical devices, though data reliability remains uncertain. Given their associated morbidity and mortality, stroke events are particularly important to monitor for cardiovascular therapies such as transcatheter left atrial appendage occlusion (LAAO). However, there are limited data comparing stroke events in contemporary claims data to events reported in large nationwide registries with comprehensive data collection. Aim: To compare stroke events in Medicare claims data with adjudicated registry-reported events in the National Cardiovascular Data Registry Left Atrial Appendage Occlusion (LAAO) Registry. Methods: LAAO Registry data were linked with 2016-2022 Medicare inpatient claims. Primary diagnosis ICD-10 codes from inpatient hospitalizations were compared to adjudicated registry-reported ischemic and hemorrhagic stroke events occurring after discharge with up to two years of follow-up. In multiple secondary analyses, primary and secondary diagnosis codes were counted as events in claims data and patients with prior history of stroke were also excluded. Results: The cohort included 71,043 adults ≥65 years old in the LAAO Registry with inpatient Medicare data. Following LAAO hospitalization discharge, there were 1405 claims-based and 1308 registry-reported total stroke events. Sensitivity and positive predictive value (PPV) of claims for identifying registry-reported events were 60.8% and 50.5% for ischemic stroke (kappa statistic 0.55), 42.7% and 50.5% for hemorrhagic stroke (kappa 0.46), and 58.1% and 54.1% for all stroke (kappa 0.55), respectively. Inclusion of secondary diagnosis codes improved sensitivity of claims (70.3% for ischemic stroke, 53.9% for hemorrhagic stroke and 67.0% for all stroke), but PPV decreased (44.8% for ischemic stroke, 34.8% for hemorrhagic stroke and 47.8% for all stroke). Specificity and negative predictive values of claims data were &gt;98% for all stroke types. Findings were similar after excluding patients with prior history of stroke ( Table ). Conclusions: Among Medicare patients in the LAAO Registry, administrative claims data had moderate agreement with adjudicated registry-reported stroke events. Claims data may not reliably capture all stroke events in real-world practice, and additional event ascertainment methods may be needed to ensure accurate assessment of stroke in post-marketing surveillance efforts.

Abstract 4119129: PREDICTING 30-DAY ALL-CAUSE READMISSION AFTER STROKE: THE APPLICATION OF MACHINE LEARNING TO LINKED REGISTRY DATA

Background: Thirty-day readmission following hospital discharge for stroke is an important quality measure for US hospitals. Current US prediction models for post stroke readmission based on electronic medical records from single healthcare systems or hospitals have modest discrimination (AUC range 0.64 - 0.74). Aim: To develop 30-day all-cause readmission prediction model using a machine learning (ML) based method trained on linked stroke registry and administrative claims data. Methods: Using probabilistic linking, we matched acute stroke (ICD-10 I61-I63) discharges from 31 hospitals participating in the Michigan Acute Stroke registry between 2016-2020 to multipayer administrative claims data provided by the Michigan Value Collaborative for Medicare and Blue Cross Blue Shield of Michigan commercial beneficiaries. Stroke registry data included patient demographics, clinical characteristics, past medical history, and treatments. Claims data was used to identify readmissions within 30 days of discharge. We used multivariable LASSO logistic regression- a simple ML technique to predict 30-day all-cause-readmission and evaluated the prediction accuracy using a hospital-split internal validation scheme to generate hospital-specific and pooled AUC estimates with 95% confidence intervals (Figure 1). Results: Of 19,382 linked stroke discharges, 2,724 (14.1%) were readmitted within 30-days. Readmitted patients were older, more likely to be male, black, and have higher stroke severity (NIHSS &gt;5). Registry hospitals were either primary (64%) or comprehensive (26%) stroke centers. Hospital-specific 30-day readmission ranged between 9.9%-23.1% ( P &lt;.001) with an average of 14.1% (95% CI:13.6%-14.5%) (Figure 2). Hospital specific AUC estimates ranged between 0.60-0.80 with a pooled AUC of 0.68 (95% CI:0.65-0.70) (Figure 2). Conclusions: ML prediction model fitted to linked registry data can be used to predict hospital-specific and statewide readmissions post stroke.