Premium
Linkage of routinely collected oncology clinical data with health insurance claims data—an example with aromatase inhibitors, tamoxifen, and all‐cause mortality
Author(s) -
Dore David D.,
Liang Caihua,
Ziyadeh Najat,
Norman Heather,
Bayliss Martha,
Seeger John D.
Publication year - 2012
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.3244
Subject(s) - medicine , aromatase , tamoxifen , linkage (software) , oncology , pharmacoepidemiology , bioinformatics , pharmacology , breast cancer , medical prescription , genetics , cancer , gene , biology
Purpose Studies of cancer based solely on health insurance claims data typically lack information on cancer clinical characteristics that are strong predictors of treatment and prognosis. Our objective was to evaluate routinely collected cancer clinical data for adjustment of confounding using an example evaluation of mortality associated with aromatase inhibitors and tamoxifen. Methods This cohort study identified women with breast cancer from 2008 through 2010 using health insurance claims data linked to clinical information on stage at diagnosis, current clinical status, histology, and other clinical markers. Estimated mortality rates (MRs) and 95% confidence intervals (CI) were compared between users of aromatase inhibitors or tamoxifen, adjusted for claims‐identified covariates and additionally for the clinical variables using propensity scores and proportional hazards regression models. Results The overall ( n = 7974) estimated MR was 69/1000 person‐years (95%CI = 62–76 person‐years), 308/1000 person‐years (95% CI = 273–345 person‐years) for women with metastasis, and 12/1000 person‐years (95%CI = 8–16 person‐years) for women without active cancer. Propensity score matching of aromatase inhibitor users ( n = 777) with tamoxifen users ( n = 535) removed many, but not all, covariate imbalances. The hazard ratios (HRs) of all‐cause mortality comparing users of aromatase inhibitors with tamoxifen users ranged from 1.0 to 1.6, with the HR most similar to previous clinical trials (0.87) coming from the claims‐only analysis. Conclusions We were able to address potential unmeasured confounders by linking clinical information to the claims data; however, there was no apparent improvement in confounding control in the chosen example. Conditioning eligibility on the clinical data restricted the sample size substantially. Copyright © 2012 John Wiley & Sons, Ltd.