Table 1.
Studies of health claims–based methods to identify metastasis and/or recurrence using small selected samples
| Author | Study aim: validation of algorithm to identify recurrence in health claims by using: | Data sources/setting | Population | Study period | Sample size/# of patients with recurrence/metastasis | Method to validate metastasis or recurrence | Findings (best algorithm) |
|---|---|---|---|---|---|---|---|
| Despande et al. (8) | ICD-9 and HCPCS codes on hospital billing data to identify local and distant metastasis for CRC patients | Barnes-Jewish Hospital Oncology Data Services inpatient/outpatient hospital billing data linked to medical record data | Consecutive cohort of patients age 65+ y with stage I-III first CRC undergoing surgery with curative intent | Cancer diagnosis: 2005–2009 Follow-up for recurrence: 2005–2010 |
174/32 | Recurrence defined as code for metastasis 3 mo after initial surgery or code for chemotherapy, radiation, or surgery at least 8 mo after initial treatment compared with medical record and tumor data* | Sensitivity-81% Specificity-99% PPV-96% NPV-96% |
| Dolan et al. (9) | ICD-9 codes on claims to identify prostate cancer metastases | Robert Wood Johnson Hospital Inpatient billing records linked to medical records | Consecutive cohort of men of all ages hospitalized with prostate cancer | Cancer diagnosis: 1986–2007 Follow-up for metastasis: 1986–2010 |
292/61 | Bone, lung, liver, and brain metastasis defined from claims based on codes compared with the medical record* | Sensitivity-95% Specificity-100% PPV-100% NPV-99% |
| Earle et al. (10) | ICD-9, CPT-4, HCPCS, and DRG codes on bills to identify relapse of acute myelogenous leukemia | Brigham and Women’s Hospital cancer registry data linked to institutional billing and medical records | Consecutive cohort of treated AML patients of all ages | Cancer diagnosis: 1991–1994 Follow-up for relapse: 1991–1996 |
89/22 | Relapse defined as claim for chemotherapy after a break in treatment of ≥4 mo compared with medical record* | Sensitivity-86% Specificity-99% PPV-95% NPV-96% |
| Eichler et al. (11) | ICD-9 diagnosis codes on bills for brain metastasis | Massachusetts General Hospital cancer registry data linked to institutional billing records and medical records | Consecutive cohort of NSCLC patients of all ages | Cancer diagnosis: 2004-2004 Follow-up for metastasis: 2004–2008 |
241/59 | Brain metastasis defined as bills with ICD-9 code for brain metastasis compared with medical record* | Sensitivity-97% Specificity-98% PPV-98% |
| Lamont et al. (12) | ICD-9 diagnosis codes for secondary neoplasm on claims to identify disease-free survival in breast cancer patients | Cancer and Leukemia Group B clinical trial data linked to Medicare claims | Medicare breast cancer patients aged 65+ participating in CALGB trial | Cancer diagnosis: 1995–1997 Follow-up for metastasis: 1995–2000 |
45/12 | DFS defined from claims compared with reporting of DFS from the CALGB data* | 2-year DFS Sensitivity-83% Specificity-95% 5-year DFS Sensitivity-100% Specificity-97% |
* Gold standard for metastasis or recurrence was standard medical record or clinical trial data. AML = acute myelogenous leukemia; CALGB = Cancer and Leukemia Group B; CRC = colorectal cancer; DFS = disease-free survival; DRG = diagnostic-related group; HCPCS = Healthcare Common Procedure Coding System; ICD = International Classification of Disease; NSCLC = non–small cell lung cancer; NPV = negative predictive value; PPV = positive predictive value.