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The American Journal of Managed Care February 2018
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Inmaculada Hernandez, PharmD, PhD; Samuel W. Bott, BS; Anish S. Patel, BS; Collin G. Wolf, BS; Alexa R. Hospodar, BS; Shivani Sampathkumar, BS; and William H. Shrank, MD, MSHS
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Claims-Based Risk Model for First Severe COPD Exacerbation
Richard H. Stanford, PharmD, MS; Arpita Nag, PhD, MBA, MS; Douglas W. Mapel, MD; Todd A. Lee, PhD; Richard Rosiello, MD; Michael Schatz, MD; Francis Vekeman, MS; Marjolaine Gauthier-Loiselle, PhD; J.F. Philip Merrigan, PhD; and Mei Sheng Duh, ScD
Variation in Markups on Outpatient Oncology Services in the United States
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Claims-Based Risk Model for First Severe COPD Exacerbation

Richard H. Stanford, PharmD, MS; Arpita Nag, PhD, MBA, MS; Douglas W. Mapel, MD; Todd A. Lee, PhD; Richard Rosiello, MD; Michael Schatz, MD; Francis Vekeman, MS; Marjolaine Gauthier-Loiselle, PhD; J.F. Philip Merrigan, PhD; and Mei Sheng Duh, ScD
A health insurance claims-based risk assessment tool to predict patients’ first severe chronic obstructive pulmonary disease exacerbation has been developed and validated.
ABSTRACT

Objectives: To develop and validate a predictive model for first severe chronic obstructive pulmonary disease (COPD) exacerbation using health insurance claims data and to validate the risk measure of controller medication to total COPD treatment (controller and rescue) ratio (CTR).

Study Design: A predictive model was developed and validated in 2 managed care databases: Truven Health MarketScan database and Reliant Medical Group database. This secondary analysis assessed risk factors, including CTR, during the baseline period (Year 1) to predict risk of severe exacerbation in the at-risk period (Year 2).

Methods: Patients with COPD who were 40 years or older and who had at least 1 COPD medication dispensed during the year following COPD diagnosis were included. Subjects with severe exacerbations in the baseline year were excluded. Risk factors in the baseline period were included as potential predictors in multivariate analysis. Performance was evaluated using C-statistics.

Results: The analysis included 223,824 patients. The greatest risk factors for first severe exacerbation were advanced age, chronic oxygen therapy usage, COPD diagnosis type, dispensing of 4 or more canisters of rescue medication, and having 2 or more moderate exacerbations. A CTR of 0.3 or greater was associated with a 14% lower risk of severe exacerbation. The model performed well with C-statistics, ranging from 0.711 to 0.714.

Conclusions: This claims-based risk model can predict the likelihood of first severe COPD exacerbation. The CTR could also potentially be used to target populations at greatest risk for severe exacerbations. This could be relevant for providers and payers in approaches to prevent severe exacerbations and reduce costs.

Am J Manag Care. 2018;24(2):e45-e53

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