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Abstract Number: 2094

Identification of Gout Flare Using an Administrative Claims Based Algorithm

Lindsey MacFarlane1, Daniel H. Solomon1 and Seoyoung C. Kim2, 1Rheumatology, Brigham and Women's Hospital, Boston, MA, 2Division of Rheumatology; Division of Pharmacoepidemiology, Brigham and Women's Hospital, Boston, MA

Meeting: 2015 ACR/ARHP Annual Meeting

Date of first publication: September 29, 2015

Keywords: Epidemiologic methods and gout, Validity

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Session Information

Date: Monday, November 9, 2015

Session Title: Epidemiology and Public Health III: Risk Factors, Treatment and Outcomes of Gout and OA

Session Type: ACR Concurrent Abstract Session

Session Time: 4:30PM-6:00PM

Background/Purpose:

Gout is a common inflammatory arthritis characterized by repeated acute flares. The ability to accurately identify gout flares is critical for comparative effectiveness studies of gout treatments. Prior studies use claims data to identify gout flares, however, these algorithms have not been validated. This study aimed to develop and validate a claims-based algorithm to identify gout flares.

Methods:

We identified patients receiving care at an academic medical center between 2006 and 2010 with a diagnosis of gout or hyperuricemia using an electronic medical record-Medicare claims linked dataset. We developed 3 algorithms to identify gout flares: 1) International Classification of Diseases, Ninth Revision (ICD-9) code for gout (274.X) and ≤ 1 dispensing for a gout-related medication including colchicine, nonsteroidal anti-inflammatory drugs, COX-2 selective inhibitors, and oral glucocorticoids ≤ 7 days from the date of gout ICD-9 code. The algorithm was run for any gout-related medication and for the individual medication categories. 2) ICD-9 code for gout and a J code for injectable glucocorticoid or a current procedural terminology (CPT) code for arthrocentesis or joint injection ≤ 7 days from the date of gout ICD-9 visit code. 3) ICD-9 code for gout and a J code for injectable glucocorticoid or a CPT code for arthrocentesis or joint injection on the same day.  Gout flares defined by the algorithms were confirmed through medical record review. Physician documentation of gout flare in the record was considered the gold standard. Positive predictive value (PPV) and 95 % confidence intervals (CI) of the algorithms were calculated. A set of 100 patients with a visit coded for gout but without any gout-related medication, arthrocentisis or injectable glucocorticoid claims was used to identify gout without flare and to calculate the negative predictive value (NPV).

Results:

503 flares were identified using the medication algorithm, and 290 were identified using the procedure ≤ 7 days algorithm. The mean age of the patients in the medication algorithm was 75 (±8) years, and 61% were male. The mean age for the procedure algorithm was 76 (±8) years and 68% were male.  The PPV of medication claims ranged from 50-54%. The PPV of the procedure claims ≤ 7 days was 59%, the same day procedure claim was stronger with a PPV of 68% (Table).  The NPV of the algorithm identifying gout without flare was 88% (95% CI 82, 94).

Table. Positive predictive value of algorithms

 

Algorithm

Records Identified

Confirmed Gout

Confirmed Flare

PPV of Flare Algorithm

 

n

n

n

                               %

(95% CI)

ICD-9 +

medication claim for any gout related medications*

503

498

268

53.3

(48.9, 57.7)

ICD-9 +

medication claim for colchicine

302

300

163

54.0

(48.4, 59.62)

ICD-9 +

medication claim for NSAID/ COX-2 selective inhibitor

174

173

87

50.0

(42.6, 57.4)

ICD-9 +

medication claim for glucocorticoids

270

266

145

53.7

(47.8, 59.7)

ICD-9 + CPT or J code within 7 days

290

287

172

59.3

(53.7, 65.0)

ICD-9 + CPT or J code on same day

196

194

134

68.4

(61.9, 74.9)

95% CI= 95% confidence interval; CI % (CI)ICD-9=International Classification of Diseases, 9thRevision; CPT= Current Procedural Terminology; PPV= Positive Predictive Value; NSAID=non steroidal anti-inflammatory;  * gout-related medications include colchicine, NSAIDs, COX-2 selective inhibitor, and glucocorticoids

 

Conclusion:

Our results suggest that a claims-based algorithm utilizing a combination of diagnosis and procedure codes as well as medications may misclassify patients as having a gout flare and caution should be used in interpreting data using claims-based definition of flares. However, as the NPV was high, the claims-based algorithm may be useful to assess the absence of gout flare or to identify a cohort of gout patients with low disease activity or disease remission.


Disclosure: L. MacFarlane, None; D. H. Solomon, Lilly, 2,Pfizer Inc, 2,AstraZeneca, 2,Amgen, 2,Corrona, 2,Genentech and Biogen IDEC Inc., 2; S. C. Kim, Pfizer Inc, 2,AstraZeneca, 2,Lilly, 2,Genentech and Biogen IDEC Inc., 2.

To cite this abstract in AMA style:

MacFarlane L, Solomon DH, Kim SC. Identification of Gout Flare Using an Administrative Claims Based Algorithm [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/identification-of-gout-flare-using-an-administrative-claims-based-algorithm/. Accessed January 31, 2023.
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