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Use of a multi‐state model in a claims database: illustration with methadone
Author(s) -
Boucherie Quentin,
Pauly Vanessa,
Frauger Elisabeth,
Thirion Xavier,
Pradel Vincent,
Micallef Joëlle
Publication year - 2015
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.3835
Subject(s) - methadone , medicine , pharmacoepidemiology , discontinuation , state (computer science) , reimbursement , capsule , database , surgery , anesthesia , pharmacology , computer science , algorithm , law , medical prescription , political science , botany , biology , health care
Purpose In pharmacoepidemiology, one of the main concerns is analysis of drug exposure time. However, in real‐life settings, patient's behavior is complex and characterized by drug exposure dynamics. Multi‐state models allow assessing the probabilities of various patterns, instead of just continuous use and/or discontinuation. The aim of this study was to illustrate with methadone, the use of multi‐state model (MSM) in a large claims database. Methods This study is based on the French health insurance reimbursement database. Methadone exposure is defined using four states for each period of follow‐up: syrup only, capsule only, syrup‐capsule and no dispensing. The model considered 12 possible transitions (including reverse transitions) from one state to another. To describe these transitions a time‐homogeneous Markov model was used. Results A total of 1265 methadone users were included. When patients belonged to the syrup‐capsule state, they had a 61.8% chance of moving to capsules the following month and 20.9% of moving to syrup. The probability of moving from the syrup to the non‐user state was 13.6% (11.7% from capsule state to non‐user state). The average length of stay was 5.9 months (CI95%: [5.5–6.4]) in capsule state, 4.9 (CI95%: [4.6–5.2]) in syrup state and 5.9 (CI95%: [5.5–6.3]) in non user state. Conclusion MSM provided a good description of methadone patterns of use. It outlined behaviors which have led to a rapid spread of capsule formulation among methadone users. Therefore, it illustrates the utility of MSM for modeling multiple sequences of drug use in a large claims database. Copyright © 2015 John Wiley & Sons, Ltd.