Medico-administrative Databases Research Articles

Economic Evaluations of Anticancer Drugs Based on Medico-Administrative Databases: A Systematic Literature Review.

Oncology is among the most active therapeutic fields in terms of new drug development projects, with increasingly expensive drugs. The expected clinical benefit and cost effectiveness of these treatments in clinical practice have yet to be fully confirmed. Health medico-administrative databases may be useful for assessing the value of anticancer drugs with real-world data. The objectives of our systematic literature review (SLR) were to analyse economic evaluations of anticancer drugs based on health medico-administrative databases, to assess the quality of these evaluations, and to identify the inputs from such databases that can be used in economic evaluations of anticancer drugs. We performed an SLR by using PubMed and Web of Science articles published from January 2008 to January 2019. The search strategy focused on anticancer drug cost-effectiveness analyses (CEAs)/cost-utility analyses (CUAs) that were entirely based on medico-administrative databases. The review reported the main choices of economic evaluation methods in the analyses. The quality of the articles was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and risk of bias assessment checklists. Of the 306 records identified in PubMed, 12 articles were selected, and one additional article was identified through Web of Science. Ten of the 13 articles were CEAs and three were CUAs. Most of the analyses were carried out in North America (n = 11). The economic metric used was the cost per life-year gained (n = 10) or cost per quality-adjusted life-year (n = 3). Reporting of the target analysis population and strategies in the articles was in agreement with the CHEERS guidelines. The structural assumptions underpinning the economic models displayed the poorest reporting quality among the items analysed. Representativeness bias (n = 11) and the issue of censored medical costs (n = 8) were the most frequently analysed risks. A comparison of the economic results was not relevant due to the high heterogeneity of the selected studies. Our SLR highlighted the benefits and pitfalls related to the use of medico-administrative databases in the economic evaluations of anticancer drugs.

A comparison of individual and ecological indicators of social deprivation and their association with hospital efficiency in the context of infectious diseases in two French general paediatric departments.

BackgroundTo identify deprivation indicators usable in everyday practice and included in medico-administrative databases, particularly with infectious diseases, which represent the greatest proportion of hospitalizations. Our objective was to compare ecological indicators to individual questionnaires and apply both types to the study of the impact of deprivation on hospital efficiency.MethodsWe conducted an epidemiological observational prospective multicentre study in two French public hospitals between 20 October 2016 and 20 March 2017. Children hospitalized for one of the four most common infectious diseases were included and their parents were asked to answer the Evaluation of Precarity and Inequalities in Health Examination Centers (EPICES) questionnaire. The ecological indicator French DEPrivation index (FDep) was derived from patients’ address, both at the zip code and at a smaller geographical area (IRIS [ilôts de regroupement pour l'information statistique]) level. Correlation and concordance between the three indicators were assessed. The endpoint used to assess the impact on hospital efficiency was the ratio between patients’ length of stay (LOS) and the national LOS of their disease-related group.ResultsData were available for 540 patients with a mean age of 9 mo. A total of 56.1% of patients were considered deprived with EPICES, 50.4% with zip code FDep and 45.7% with IRIS FDep. Concordance between EPICES and either type of FDep was <0.1. There was no increase in LOS compared with national LOS with any of the indicators.ConclusionsIndividual and ecological indicators do not measure the same aspects of deprivation. The decision to use one or the other must be carefully weighed when studying the impact of deprivation on the healthcare system.

The Quebec Low Back Pain Study: a protocol for an innovative 2-tier provincial cohort.

The neurobiological mechanisms underlying recovery from or persistence of low back pain (LBP) remain misunderstood, limiting progress toward effective management. We have developed an innovative two-tier design to study the transition from acute to chronic LBP. The objective of the first tier is to create a provincial web-based infrastructure to recruit and monitor the trajectory of individuals with acute LBP. The objective of the second tier is to fuel hypothesis-driven satellite data collection centers with specialized expertise to study the role of biomechanical, epigenetic, genetic, neuroanatomical, ontological, physiological, psychological, and socioeconomic factors in LBP chronicity. This article describes the first tier of the protocol: establishment of the Core Dataset and Cohort. Adults with acute LBP will be recruited through networks, media, and health care settings. A web-based interface will be used to collect self-reported variables at baseline and at 3, 6, 12, and 24 months. Acute LBP will be defined according to the Dionne 2008 consensus. Measurements will include the Canadian minimum data set for chronic LBP research, DN4 for neuropathic pain, comorbidities, EQ-5D-5L for quality of life, and linkage with provincial medico-administrative databases. The primary outcome will be the transition to chronic LBP, as defined by Deyo 2014. Secondary outcomes include health care resource utilization, disability, sick leave, mood, and quality of life. This study brings together diverse research expertise to investigate the transition from acute to chronic LBP, characterize the progression to recovery or chronicity, and identify patterns associated with that progression.

Relevance of the health insurance databases to study potentially inappropriate prescriptions

Abstract Issue/problem Potentially inappropriate prescriptions (PIP) for the elderly constitute a major issue in the quality of ambulatory care. In France, people aged 80 years or older use on average five drugs per day. This polypharmacy is justified in most cases by multimorbidity but it increases the risk of adverse events. Description of the problem In order to optimize general practitioners’ (GPs) prescribing practices for the elderly, a project involving the Southeastern Health Regional Observatory (ORS Paca), the Regional Medical Department of Health Insurance Fund (DRSM Paca-Corse) and the Regional Union of Private Practitioners (URPS-ML Paca) was conducted in 2014-2016. Its main objective was to set up a regional mapping tool giving GPs access to drug prescriptions indicators for the elderly in their practice area. Results Based on national guidelines and advice of experts in the field, we calculated 7 different indicators of potentially inappropriate prescriptions (PIPs) for people aged 65 years or older, using drug reimbursement data from the Health Insurance Fund. Those indicators were calculated among patient lists of GPs and covered prescriptions of benzodiazepines, non-steroidal anti-inflammatory (NSAI) drugs, new oral anticoagulants, proton pump inhibitors, antiplatelet therapy... PIPs’ prevalence were calculated among GPs’ lists of patients. PIPs prevalence differed between drugs type, GPs and territories: for example, the age standardized prevalence of long-term treatment with NSAI drugs varied in 2014 from 2 to 15% between municipalities and from 0 to 14% in 2017. Lessons These results allowed to identify priority areas for intervention, in which continuous medical education sessions with an individual feedback to GPs on their own indicators were implemented, to improve prescribing practices. Key messages A substantial proportion of elderly people receive PIPs. Medico-administrative databases can be used to produce indicators of prescription practices to be used to guide public health interventions.

A claims-based algorithm to identify cancers in a French retired self-employed craftspeople cohort

Abstract Background In France, possible long-term effects of past occupational exposure to carcinogen in the French retired self-employed craftspeople (RSEC) was studied in the ESPrI cohort. For health surveillance, a passive epidemiologic follow-up was set up, using algorithms based on medico-administrative databases developed to identify retiree with incident cancers. Methods A total of 15,030 RSEC were invited between 2005 and 2009 to fill the questionnaire about social and demographic characteristics, occupational history, frequency of activities involving potential exposure to asbestos fibers. For health surveillance, health-related French administrative databases were used. Since 2009, healthcare data from 7,544 ESPrI retirees had been annually extracted from the national health insurance cross-fund information system (Sniiram), include the French hospital discharge database system (PMSI) and the registered Long-Term Diseases database (LTD). The objective was to track incident cancers (ICD-10) and their date of diagnosis using algorithm based on 1) hospital stay with principal, related or associated diagnosis; 2) historic of the registered LTD which was available for each retiree. Results Among 7 544 ESPrI retirees, matching through medical records, 256 different incident cancers from asbestos-related localizations were identified between 2011 and 2017, 243 in men and 13 in women - a total number of 105 lung cancers, 122 colorectal cancers and 29 others cancers (mesothelioma, larynx, ovarian, oesophagus, pleura cancers). Conclusions A passive follow-up by using French national health administrative databases in order to evaluate the potential health effect of occupational asbestos exposure offered the advantage of reducing the risk of attrition and decreasing the total cohort cost. In 2019, a study was set up with then French cancer registries to evaluate algorithm’s performance. Key messages A claims-based algorithm developed by the French public health Agency to identify incident cancers. Epidemiological follow-up of ESPrI cohort provides indicators on the health of retired self-employed craftspeople.

Analyse des comorbidités chez les patients hospitalisés pour un accident vasculaire cérébral ischémique et leurs influences sur la létalité

ObjectivesThe aim of the study consists of analyzing the comorbidities of acute ischemic stroke and those influencing its hospital lethality. MethodsWe considered patients from Wallonia aged 25 years or more and admitted to a Belgian hospital for an acute ischemic stroke in 2013 and 2014. The analyzed medico-administrative data are taken from the Minimum Hospital Summary. A factorial correspondence analysis (FCA) was used to demonstrate the comorbidities profiles. A logistic regression was used to analyse the comorbidities influencing hospital lethality by ischemic stroke. ResultsThe stroke risk factors vary according to the age. Cardiac problems are more common in older people aged 85 years or more. High blood pressure, hypercholesterolemia and diabetes are more present between 65- and 84-year-olds. Overweight is more present between 55 and 74-year-olds. People who are addicted to alcohol or tobacco are often 65 years or younger. The logistic regression showed that age and heart problems are the risk factors that increase lethality. However there is a lethality diminution in the presence of high blood pressure, hypercholesterolemia, overweight and addiction to alcohol or tobacco. ConclusionThis study demonstrates that medico-administrative databases and factorial statistical methods are perfectly adapted to confirm the ischemic stroke risk factors. This type of study will allow to target with more precision the secondary and tertiary prevention actions of stroke.

Depression and obesity, data from a national administrative database study: Geographic evidence for an epidemiological overlap.

BackgroundDepression and obesity are two major conditions with both psychological and somatic burdens. Some data suggest strong connections between depression and obesity and more particularly associated prevalence of both disorders. However, little is known about the geographical distribution of these two diseases. This study aimed to determine if there is spatial overlap between obesity and depression using data from the entire French territory.MethodsData for 5,627 geographic codes for metropolitan France were collected from the two national hospital databases (PMSI-MCO and RIM-P) for the year 2016. We identified people who were depressed, obese or both registered in the two public medico-administrative databases, and we assessed their location. In addition, a multivariable analysis was performed in order to determine geographic interactions between obesity and depression after controlling for age, sex, environmental and socio-economic factors (social/material deprivation, urbanicity/rurality).Results1,045,682 people aged 18 years and older were identified. The mapping analysis showed several cold and hot regional clusters of coinciding obesity and depression. The multivariable analysis demonstrated significant geographic interactions, with an increasing probability of finding a high prevalence of obesity in regions with major depression (OR 1.29 95% CI 1.13–1.49, p = 0.0002) and an increased probability of finding a high prevalence of depression in regions with a high ration of obesity (OR 1.32, 95% CI 1.15–1.52, p<0.0001).ConclusionOur study confirms the significant bidirectional relationships between obesity and depression at a group level. French geographic patterns reveal a partial overlap between obesity and depression, suggesting these two diseases can be included in a common approach. Further studies should be done to increase the understanding of this complex comorbidity.

Sexual Health Problems and Discussion in Colorectal Cancer Patients Two Years After Diagnosis: A National Cross-Sectional Study

BackgroundColorectal cancer (CRC) is accompanied by specific treatment-related physical (ostomy, incontinence) and psychosexual (body image, depression) consequences on sexual health. AimTo assess sexual health of patients with CRC 2 years after diagnosis. MethodsWe selected all patients with CRC from a French nationwide longitudinal study. Data sources included patient questionnaires, medical questionnaires, and medico-administrative databases. Main Outcome MeasureWe evaluated sexual health using the Relationship and Sexuality Scale and assessed self-reported rates of discussion about sexuality with health care providers. ResultsAcross the 487 patients, 258 were men and 229 were women; 77% were diagnosed with colon cancer and 23% with rectal cancer. Overall, 54% of patients reported a decrease in sexual desire, 61% a decrease in frequency of intercourse, and 48% a decrease in the possibility to reach an orgasm. Patients still experiencing fecal incontinence 2 years after diagnosis had decreases in all sexual desire, intercourse, orgasm, and satisfaction Relationship and Sexuality Scale items. Patients with rectal cancer had significantly more frequent troubles with desire and orgasm than did patients with colon cancer (P = .003 and P = .014, respectively). Regarding the discussion about sexuality, only 20% of men, 11% of women, 11% of patients with colon cancer, and 33% of patients with rectal cancer recalled having discussed sexuality with the medical team. Factors independently increasing the chance to have discussed sexuality with the medical team were younger age (odds ratio [OR] = 2.77 [1.31; 5.84]; P = .007), having an ostomy (OR = 2.93 [1.27; 6.73]; P = .011), and radiotherapy (OR = 2.78 [1.23; 6.27]; P = .014). Clinical ImplicationsThese results highlight the need for developing interventions to improve information delivery at cancer announcement and for managing sexual troubles during survivorship in patients with CRC, particularly those experiencing fecal incontinence. Strength & LimitationsStrengths are the sample size and the national representation using the data of a large-scale nation-wide survey, with the possibility of comparing colon and rectal cancers. Limitations are the assessment of sexuality 2 years after diagnosis and using only self-reported measures. ConclusionThis study highlights the lack of discussion about sexuality with the oncology team and the need for specific sexual rehabilitation interventions, especially for patients with rectal cancer and fecal incontinence. Developing these aspects may help patients with CRC improve their sexual prognosis.Almont T, Bouhnik A-D, Charif AB, et al. Sexual Health Problems and Discussion in Colorectal Cancer Patients Two Years After Diagnosis: A National Cross-Sectional Study. J Sex Med 2019;16:96–110.

Trends in childhood type 1 diabetes incidence in France, 2010–2015

AimsTo estimate type 1 diabetes incidence in children in France and its evolution between 2010 and 2015, based on comprehensive medico-administrative databases. MethodsThe algorithm built to identify new cases of type 1 diabetes selected children aged between 6 months and 14 years who had at least one hospital stay for diabetes, followed by their first insulin treatment, excluding children suffering from another form of diabetes.Age and sex specific annual incidence rates were estimated and time trend was analyzed using Poisson regression. ResultsA total of 12 067 children were identified as newly diagnosed with type 1 diabetes and the annual incidence rates increased between 2010 and 2015 (from 15.4 [95% Confidence Interval: 14.7; 16.1] to 19.1 [18.3; 19.9] per 100 000 person-years), among boys and girls, and in each age group (4 and under, 5–9, 10–14 year olds). The annual rate of increase was 4.0% [3.4; 4.6]. This trend was not significantly different between each gender, and each age group. ConclusionsValid database information on disease incidence is essential for healthcare planning and provides a valuable resource for health research. An increase of the incidence rate of type 1 diabetes in children was highlighted in both sexes and in all age groups.

A Fixed Effect Analysis of the Variation of Socioeconomic and Environmental Factors and Rate of Asthma Onset in Children Overtime within Regions of Qu&amp;#233;bec (Canada)

Socioeconomic conditions and exposure to air pollutants have been related to cardiorespiratory outcomes. Nonetheless, very few studies have looked at how changes in environmental and socioeconomic conditions overtime relate to changes in health outcomes.We assessed the relationships between the changes in environmental and socioeconomic conditions and change in asthma onset in children &amp;lt;13 years within small geographic units of Qu&amp;#233;bec (i.e. census tracts or local health regions called CLSC) using an ecological longitudinal design. We used univariate and multivariate fixed effects negative binomial models with the population of children aged 0-14 years per geographical area as an offset to assess associations. New cases of asthma were identified from linked medico-administrative databases using a validated algorithm. For the 1386 areas, we computed for the years 2002 to 2011, the median income from the Census, the average regional background of fine particulate levels (PM2.5) estimated with ground and satellite information, the reported industrial air pollutant emissions of PM2.5 and sulfur dioxide (SO2). We also used environmental tobacco smoke (ETS) information from the Canadian CCHS survey for 18 health regions to estimate exposure of children to environmental tobacco smoke (ETS) for the years 2002 to 2011.From a multivariate model, there was a 4.21% increase in the rate of asthma onset per change of 1 ug/m3 of regional PM2.5 levels (95%CI: 3.3-5.0), and 2.88% increase per change of 1 percent of ETS (95%CI: 2.6-3.1) within studied areas. In this model, median income and industrial emissions were not significantly related to the rate of asthma onset. Our findings suggest that small area changes in regional PM2.5 levels and in ETS, which have both decreased over the years, are associated with improvements in asthma outcomes in Qu&amp;#233;bec.

Big-data and occupational health surveillance: Screening of occupational determinants of health among French agricultural workers, through data mining of medico-administrative databases

Introduction Surveillance of diseases and associated exposures is a major issue in occupational health especially for identifying new work-related diseases. In addition to classical epidemiology (hypothesis-driven studies), complementary methods relying on data mining of health insurance data must be developed for early detection of work-related diseases, without any prior hypothesis. For this reason, the social security system of French agricultural workers “Mutualite sociale agricole” (MSA) emphasized the potential interest of a surveillance system through the exploitation of their up-to-date databases created for reimbursement of medical expenses. In partnership with the French Agency for Food, Environmental and Occupational Health and Safety (Anses), a pilot study has been set up in order to develop an innovative approach of data mining to look for associations between long-term diseases (LTD) and occupational activities. Methods The MSA was covering 3.2 million individuals in 2016, with about 1.2 million of active workers. Among them, the study population included all self-employed and steady employees, potentially including individuals who may have retired from 2007, that were registered at least once in MSA databases between 2006 and 2015. MSA holds administrative and medico-administrative databases which include occupational activities, socio-demographic variables (age, sex, incomes), as well as LTD, identified through ICD-10 codes. Following due authorizations especially of the French independent data protection authority (CNIL), MSA databases were cross-linked for the first time and restructured in order to apply logistic models and latent factor models. Obtained p-values and odds ratio (OR) were represented on graphics to highlight the key statistical signals of over-represented statistical associations between occupational activity and LTD. Results The population covered by this study accounted for about 2 million individuals (active workers or retirees), with about 900,000 self-employed and 1.2 million steady employees. In both databases, there was a majority of men (65.7%) and the average age was significantly different (P Conclusions This pilot study permitted to prove the feasibility and the relevance of using MSA data for health surveillance of occupational risks among agricultural workers. This approach has the following advantages: 1) enabling systematic evaluations of all disease–occupational activity associations, 2) high statistical power and 3) costless data acquisition. The main drawback is its lack of direct information regarding exposure. For this reason, in partnership with the French national public health agency “Sante publique France”, further work is currently performed to estimate retrospectively pesticides use relying on previous activities and crop-exposure matrices. This data mining approach will later be enriched by identifying diseases using the drugs consumption as a proxy via specific algorithms.

Evaluation of the impact of terminating the reimbursement of a therapeutic class of drugs on the French health system: The example of symptomatic slow-acting drugs for osteoarthritis (SYSADOAs)

Introduction The French social security has had a balanced budget as a recurring objective for several decades, with a specific target on the National Health Insurance (NHI) branch. Over the past several years, efforts have intensified, with a continuing policy on decreasing drug prices, developing ambulatory care to limit hospitalizations or reducing the reimbursement of some specialists. Decreasing the reimbursement rate of drugs reduces, as a direct effect, the prescription and delivery of the targeted drugs. However, the substitution effect in favor of still reimbursed drugs should not be forgotten, because it could minimize the intended effect in economic terms as well as in terms of public health. The recent French decision to terminate the reimbursement of Symptomatic Slow-Acting Drugs for Osteoarthritis (SYSADOAs) is an interesting case study for the impact of terminating the reimbursement a drug from a collective perspective. The aim of the present study was to investigate prescription substitutions in favor of analgesics and non-steroidal anti-inflammatory drugs (NSAIDs), both in terms of volumes and costs, as well as the occurrence of their potentially associated adverse effects (AEs) using a methodology based on access to national administrative databases. Methods To quantify these effects in the most exhaustive manner, French medico-administrative databases were used (EGB - general sample of beneficiaries; PMSI - program for medicalization of hospital information systems). Three study periods were considered to cover a potential historical bias: the primary period was defined around the date of reimbursement termination (2015/03/01), considering one year both pre and post cutoff; the secondary period was defined in the same manner around the date of the reimbursement rate decrease (35% to 15% on 2011/12/01); a control period was considered with a cutoff date (2009/03/01) chosen to reduce seasonal variations impact as comparator of the primary period. We defined the population on each of these periods on two criteria: they were at least 40 and had had at least one SYSADOA delivery in the year prior to the cutoff. We considered subgroups on the delivery persistence and prevalence. We performed comparisons for the following events, quantified in volumes and in costs: NSAID deliveries, analgesic deliveries, hospitalizations for cardiovascular or gastric causes, or for renal insufficiency, and surgery for arthritis. Results The analyses concerned respectively 19,345, 20,066, and 16,200 patients in the control, secondary and primary periods. Among the patients, 4345 were present in all 3 periods. The classification of patients according to delivery persistence remained stable over the three periods. We observed a decrease of incident patients. The volume of NSAID deliveries decreased over the three periods from a total of 40.5 (± 76.3) defined daily dose (DDDs) per patient in 2008 to 29.6 (± 66.4) DDDs in 2015. The number of analgesic DDDs increased constantly over the three study periods, from 70.2 (± 108.9) DDDs in 2008 to 76.9 (± 123.1) DDDs in 2015. Regarding the costs, there was an overall decrease over the three study periods of the amount reimbursed by NHI for all deliveries and for hospitalizations. The effects being quantitatively comparable in all three periods, it was not possible to conclude from these data that terminating the reimbursement of SYSADOAs had an impact on the French NHI. Conclusion The information available in medico-administrative databases makes it possible to study the impact of a change of policy in the reimbursement schemes by allowing the constitution of large representative cohorts at the national level. However, our results underline how the measured effects were restricted to those impacting NHI: OTC deliveries or out-of-pocket expenses were not evaluable with these data sources alone. Thus, the impact in terms of public health can only be partially measured.

The ACIRA registry: A tool to analyze the coronary intervention post-hospital pathway in the French Aquitaine region

Coronary angiography (CAG) and percutaneous coronary intervention (PCI) are invasive cardiology procedures associated with important costs and high readmission rates. The CAG and PCI pathway after patient discharge is currently unknown in France. The aim of this study is to present the one-year readmission and in-hospital mortality results in the French Aquitaine region in 2013. We analyzed 30-day and one-year all-cause readmission and in-hospital mortality after CAG and PCI using the ACIRA registry of 9 interventional institutions. Readmissions, in-hospital complications, cardiovascular morbidity and mortality are collected from the French medico-administrative databases, during one year after the initial procedure. A probabilistic matching method is used to merge the ACIRA and medico-administrative databases. Overall, 62.6% of the patients were rehospitalized after one year. In-hospital readmission deaths were 3.5%, including cardiovascular-related deaths in 41.5% of the cases. Moreover, 16.8% of the patients had at least one other CAG or PCI procedure ( Table 1 ). ACIRA results illustrate the capacity to study the CAG and PCI pathway up to one year following the procedure. We found that in-hospital cardiovascular complications and 30-day all-cause readmission rate after PCI were particularly high. A deeper analysis to explain these high readmission rates is in progress.

Utilisation des bases de données médico-administratives du Québec pour des études en santé mentale : opportunités, défis méthodologiques et limites – cas de la dépression chez les personnes diabétiques

The use of medico-administrative databases for studies on mental health issues is very common because of the large number of people in these databases and the possibility to carry out long-term studies. Several challenges, such as identifying people with a disease of interest or being exposed to a risk factor, have to be overcome through validation studies to ensure an optimal use of these resources. Moreover, limits (lack of certain relevant information) and the coverage of about 40% of Quebec's population by the public drug plan are to be considered in the interpretation and generalization of research results based on these data sources. In the specific case of depression, we used these databases to determine the incidence of depression among diabetic individuals in Quebec. This required the use of a previously validated algorithm (validated in another province) that we modified to define and identify the cases of depression in the RAMQ databases. We observed an incidence of depression of 9.47 persons years over a follow-up of 8 years. Finally, we assessed the impact of depression on adherence and persistence with antidiabetic drugs as well as the factors that affect patients' use of these drugs. Our results suggest that depression has a negative impact on the use of antidiabetic drugs and allow the identification of possible solutions.

Do intra-articular hyaluronic acid injections delay total knee replacement in patients with osteoarthritis - A Cox model analysis.

Due to the growing worldwide prevalence of knee osteoarthritis, the optimal management of this issue is critical for reducing its burden.ObjectivesThis study aimed to describe patients treated for knee osteoarthritis between 2006 and 2013 in France and to compare the delay from diagnosis to total knee replacement between patients who received intra-articular hyaluronic acid injections and those who did not receive the injections. A second objective was to compare direct medical costs for ambulatory care between treatment groups.Materials and methodsPatients were selected from a representative sample of the real world administrative claims database using an algorithm developed by experts from the scientific committee of the study. Data were matched with the medico-administrative database for hospital care. A Cox proportional hazards model was stratified for the treatment group and adjusted for available socio-demographic and medical covariates to compare restricted mean survival times at different time points (1, 3, 5 and 7.5 years) between groups. Costs were expressed in 2013 euros.ResultsA total of 14,782 patients were treated for knee osteoarthritis (67% women; mean age = 68 years). Among this population, 1,662 patients had total knee replacement (11.2%). At each time point, restricted mean survival time without total knee replacement was significantly higher (p-values<0.001) for hyaluronic acid group, from +51 to +217 days at 1 and 7.5 years, respectively. For the year preceding total knee replacement, the means for total direct medical costs were similar between groups, €744 vs €805 for treatment and control groups, respectively, (p-value = 0.104). Intra-articular injections accounted for less than 10% of the total costs.ConclusionThis is the first retrospective longitudinal study involving knee osteoarthritis patients using medico-administrative databases in France. The results support the effectiveness of hyaluronic acid injections in delaying total knee replacement and show that patients treated with hyaluronic acid have similar direct medical costs for ambulatory care compared to patients treated with corticosteroids only.

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

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.

Étude des algorithmes de repérage de la schizophrénie dans le Sniiram par le réseau REDSIAM

BackgroundThe aim of the REDSIAM network is to foster communication between users of French medico-administrative databases and to validate and promote analysis methods suitable for the data. Within this network, the working group “Mental and behavioral disorders” took an interest in algorithms to identify adult schizophrenia in the SNIIRAM database and inventoried identification criteria for patients with schizophrenia in these databases. MethodsThe methodology was based on interviews with nine experts in schizophrenia concerning the procedures they use to identify patients with schizophrenia disorders in databases. The interviews were based on a questionnaire and conducted by telephone. ResultsThe synthesis of the interviews showed that the SNIIRAM contains various tables which allow coders to identify patients suffering from schizophrenia: chronic disease status, drugs and hospitalizations. Taken separately, these criteria were not sufficient to recognize patients with schizophrenia, an algorithm should be based on all of them. Apparently, only one-third of people living with schizophrenia benefit from the longstanding disease status. Not all patients are hospitalized, and coding for diagnoses at the hospitalization, notably for short stays in medicine, surgery or obstetrics departments, is not exhaustive. As for treatment with antipsychotics, it is not specific enough as such treatments are also prescribed to patients with bipolar disorders, or even other disorders. It seems appropriate to combine these complementary criteria, while keeping in mind out-patient care (every year 80,000 patients are seen exclusively in an outpatient setting), even if these data are difficult to link with other information. Finally, the experts made three propositions for selection algorithms of patients with schizophrenia. ConclusionPatients with schizophrenia can be relatively accurately identified using SNIIRAM data. Different combinations of the selected criteria must be used depending on the objectives and they must be related to an appropriate length of time.

Evaluation of algorithms to identify incident lymphoma cases using claims databases with cancer registry

Background There is a huge increase in the use of medico-administrative databases for research purposes. For this reason, some selection algorithms have been validated with cancer registry data to detect incident cancer cases. However, there is no validated algorithm to identify Non-Hodgkin's Lymphoma (NHL) and Hodgkin's Lymphoma (HL) incident cases. Aims of this study were to assess the validity of diagnosis codes in the PMSI database to identify incident cases of Lymphomas according to results of the Tarn cancer registry and to compare baseline characteristics of lymphoma cases using both sources. Methods Between 2010 and 2013, inhabitants of the tarn department with lymphomas were identified in the PMSI through two algorithms of selection (combination of diagnosis codes of lymphomas and chemotherapy for Algorithm 1, only diagnosis code of lymphomas for algorithm 2). Then, only incident lymphoma cases were selected using the past history of patients. An incident case must have no previous record of lymphoma diagnosis during an observation period of 24 months. The results of the selection and characteristics of incident lymphomas cases were compared with data from the tarn cancer registry considered as the “gold standard” in this area. Each algorithm performance was assessed by estimating sensitivity (Se), predictive positive value (PPV), specificity (Spe) and negative predictive value (NPV). Results Between 2010 and 2013, the registry identified 485 validated incident cases of lymphomas, of which 52 HL cases and 433 NHL cases. For corresponding area and period, algorithm 1 provides a number of incident cases close to the registry whereas Algorithm 2 overestimated the number of incident cases by approximately 30%. For algorithm 1, sensitivity and PPV were closed, respectively 66.2% and 67.7%. For algorithm 2, sensitivity was increased by up 10% whereas PPV was decreased by up 9%. Both algorithms presented high specificity and NPV (≈98%). The comparative analysis illustrates that similar distribution and characteristics are observed when using both sources. Conclusion Given these results, identifying incident Lymphoma patients through data collected from the French national health insurance database may be useful to conduct national pharmaco-epidemiological studies on Lymphomas. These results suggest that using both diagnosis codes and chemotherapy codes appears to be a more efficient method to detect incident cases.

Immeasurable time bias due to hospitalization in medico-administrative databases: which impact for pharmacoepidemiological studies?

Drugs administered to hospitalized patients are not available within almost all health insurance databases. However, this unobservable exposure time bias is very rarely taken into account in pharmacoepidemiology. The objective was to model unobservable periods due to hospitalization and to assess their impact on risk estimates in the context of the association between benzodiazepines and mortality. A cohort study was identified using the General Sample of Beneficiaries in France for the period 2006-2012. Benzodiazepines incident users were matched to incident users of antidepressants/non-benzodiazepine sedatives and to controls (non-users) according to age and gender. All-cause mortality at 1year (Cox regression model) was studied using time-dependent variables (exposed/unexposed or under two hypotheses, inpatients are exposed or inpatients are unexposed), complemented with a multistate model based on observable/unobservable/death status. In each group, 57242 patients were included. All-cause mortality was significantly higher among those exposed to benzodiazepines (adjusted hazard ratio (aHR)=1.17, 95% confidence interval (CI)=1.04, 1.32), as compared with controls. Use of benzodiazepines exposure as a time-dependent variable resulted in significant results after adjustment (aHR=1.45, 95%CI=1.16, 1.80). When inpatients were considered as unexposed, all-cause mortality was not significantly increased (aHR=0.85, 95%CI=0.76, 1.10), but was significantly augmented when inpatients were considered as exposed (aHR=2.93, 95%CI=2.46, 3.48). This study highlights the need to take account of the impact of unobservable exposure periods on risk estimates. Copyright © 2017 John Wiley & Sons, Ltd.

French Medico-Administrative Data to Identify the Care Pathways of Women With Breast Cancer

BackgroundStudy of the care pathways is an important topic for care planning, as well as to observe guidelines application. This study aimed to describe care pathways and the period of time between treatments of women with breast cancer (BC), at a population level. Materials and MethodsWomen with in situ, local and regional BC who were hospitalized and newly treated in 2012 were included and followed for 1 year. Care pathways were described, focusing on surgery (partial mastectomy [PM], total mastectomy [TM]), chemotherapy, and radiotherapy. The periods of time between treatments were measured and compared with the guidelines. ResultsThe study involved 52,128 women. The most common care pathways among the 2845 women with in situ BC were PM-radiotherapy (46.7%) and TM (28.5%). Among the 41,470 women with local BC, they were: PM-radiotherapy (44.8%) or PM-chemotherapy-radiotherapy (16.0%). The 7813 women with regional BC had similar care pathways, although chemotherapy was given more frequently (73%). The periods of time between surgery and chemotherapy were in accordance with the guidelines for 98% of the women; those between surgery and radiotherapy were affected by adjuvant chemotherapy. Finally, the time between chemotherapy and radiotherapy was longer than recommended for 40% of the women. ConclusionThe French medicoadministrative databases allow the study, at a national population level, of the care pathways and periods of time between treatments of women with BC according to the stage of the disease. They were close to the guidelines, although an improvement is highly necessary.