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ABSTRACT: In the United States, data on transplanted and waitlisted patients collected by the Organ Procurement and Transplantation Network (OPTN) have been widely used in transplantation research. Administrative claims data, collected by health plans for reimbursement purposes, are also commonly used in health-services research. This study linked OPTN and private payer claims data to assess the relationship between data elements common to both sources.
All transplanted or waitlisted patients in the registry were considered for inclusion. A multistep match algorithm was employed to link OPTN and payer data from years 1995 to 2004. Variables common to both datasets that contained relevant information for similar time periods were compared.
A total of 21,419 solid organ transplant recipients and 8808 waitlist patients were included in the final linked database. Organ type and demographic variable distributions in the linked dataset were similar to the overall OPTN database. Using claims as the reference group, sensitivity and specificity values were on average 0.72 and 0.69, respectively, and were highest for the indicators of immunosuppression use at discharge and follow-up.
This comparison of payer data with information reported by transplant centers to the OPTN provides important insight into the value of both data sources. Using administrative claims to augment the registry data with utilization and cost information will be useful for evaluation of both economic and clinical endpoints in solid organ transplantation.
Medical Care 07/2007; 45(6):529-36. · 3.41 Impact Factor
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ABSTRACT: Objective: This study developed and validated a claims-based algorithm for identifying patients with irritable bowel syndrome (IBS) and investigated the characteristics of patients associated with a correct identification. Methods: Using a classification tree procedure, a claims-based algorithm was developed and tested against medical chart findings. Patients' medical charts were reviewed to verify diagnoses. The classification tree separated the patient population into 12 mutually exclusive subgroups and had an overall positive predictive value (PPV) of 70%. Setting and Participants: Claims data were obtained for adults aged 18 years or older who were enrolled in a large health maintenance organization in California, USA, during the study period (January 1 1997 to June 30 1999) and who had at least one claim with a primary International Classification of Diseases Ninth Revision Clinical Modification (ICD-9-CM) diagnosis of 564.1 (irritable colon) in 1998. In October 2000 this code description was revised to `irritable bowel syndrome'. Results: The PPVs of end nodes of the tree varied (18 to 100%) depending on the demographic, type of resource utilized, and diagnoses characterizing the 12 groups. Younger patients (aged <50 years) and those with several claims with a 564.1 ICD-9-CM code were more likely to be patients with IBS. The PPV for each of these 12 subgroups could be used as a covariate in regression models that predict outcomes of IBS and its management. Conclusions: Claims databases provide an efficient and effective tool for conducting health services research on large patient populations. Medical record validation of claims-based algorithms is an important step in improving the reliability and utility of these databases.
Disease Management and Health Outcomes 01/2002; 10(11):715-722. · 0.36 Impact Factor
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ABSTRACT: Tegaserod is effective, safe, and well-tolerated in the treatment of patients with irritable bowel syndrome (IBS) with constipation. The aim of this study was to assess, from a payer perspective, the cost-effectiveness of tegaserod in the treatment of IBS patients, based on the TEgaserod in NORdic region (TENOR) trial data.
Female and male patients (Rome II criteria) were randomized to receive tegaserod 6 mg b.i.d. or placebo for 12 weeks. Patients (247 tegaserod; 238 placebo) completed the EuroQol EQ-5D questionnaire at baseline, Week 4, and Week 12. A 12-week economic study was undertaken to assess the incremental cost-effectiveness ratio (ICER) of tegaserod in terms of cost per quality-adjusted life-year (QALY) gained. Cost-effectiveness acceptability curves were calculated to estimate the probability of tegaserod being cost-effective at different benchmark values of cost per QALY gained.
By assuming a daily drug cost to payers of Euro 2, Euro 3, and Euro 4, the ICER of tegaserod ranges between Euro 19,000 and Euro 38,000 per QALY gained, with the percentage of the bootstrap estimates below the willingness to pay level of Euro 50,000 per QALY gained ranging between 90% and 69%.
This study established directly from a randomized controlled clinical trial that tegaserod is cost-effective in the treatment of non-D-IBS patients.
Value in Health 10(4):238-46. · 2.19 Impact Factor
