Derivation and preliminary validation of an administrative claims-based algorithm for the effectiveness of medications for rheumatoid arthritis
1 Department of Medicine, University of Alabama, 510 20th Street South, FOT 805D, Birmingham, AL 35294, USA
2 Department of Medicine, Birmingham VA Medical Center, 700 19th Street South, Birmingham, AL 35233, USA
3 Division of Rheumatology, Omaha VA Medical Center, 4101 Woolworth Avenue, Omaha, NE 68105, USA
4 Division of Rheumatology, University of Nebraska Medical Center, 42nd and Emile, Omaha, NE 68198, USA
5 George E Wahlen VA Medical Center, 500 Foothill Drive, Salt Lake City, UT 84148, USA
6 Division of Rheumatology, University of Utah, 30 North 1900 East, SOM4B200, Salt Lake City, UT 84132, USA
Arthritis Research & Therapy 2011, 13:R155 doi:10.1186/ar3471Published: 20 September 2011
Administrative claims data have not commonly been used to study the clinical effectiveness of medications for rheumatoid arthritis (RA) because of the lack of a validated algorithm for this outcome. We created and tested a claims-based algorithm to serve as a proxy for the clinical effectiveness of RA medications.
We linked Veterans Health Administration (VHA) medical and pharmacy claims for RA patients participating in the longitudinal Department of Veterans Affairs (VA) RA registry (VARA). Among individuals for whom treatment with a new biologic agent or nonbiologic disease-modifying agent in rheumatic disease (DMARD) was being initiated and with registry follow-up at 1 year, VARA and administrative data were used to create a gold standard for the claims-based effectiveness algorithm. The gold standard outcome was low disease activity (LDA) (Disease Activity Score using 28 joint counts (DAS28) ≤ 3.2) or improvement in DAS28 by > 1.2 units at 12 ± 2 months, with high adherence to therapy. The claims-based effectiveness algorithm incorporated biologic dose escalation or switching, addition of new disease-modifying agents, increase in oral glucocorticoid use and dose as well as parenteral glucocorticoid injections.
Among 1,397 patients, we identified 305 eligible biologic or DMARD treatment episodes in 269 unique individuals. The patients were primarily men (94%) with a mean (± SD) age of 62 ± 10 years. At 1 year, 27% of treatment episodes achieved the effectiveness gold standard. The performance characteristics of the effectiveness algorithm were as follows: positive predictive value, 76% (95% confidence interval (95% CI) = 71% to 81%); negative predictive value, 90% (95% CI = 88% to 92%); sensitivity, 72% (95% CI = 67% to 77%); and specificity, 91% (95% CI = 89% to 93%).
Administrative claims data may be useful in evaluating the effectiveness of medications for RA. Further validation of this effectiveness algorithm will be useful in assessing its generalizability and performance in other populations.