The sensitivity of Medicare claims data for case ascertainment of six common cancers.
BACKGROUND
Although Medicare claims data have been used to identify cases of cancer in older Americans, there are few data about their relative sensitivity.


OBJECTIVE
To investigate the sensitivity of diagnostic and procedural coding for case ascertainment of breast, colorectal, endometrial, lung, pancreatic, and prostate cancer.


METHODS
Three hundred and eighty nine thousand and two hundred and thirty-six patients diagnosed with cancer between 1984 and 1993 resided in one of nine Surveillance Epidemiology and End Results (SEER) areas.


METHODS
The sensitivity of inpatient and Part B diagnostic and cancer-specific procedural codes for case finding were compared with SEER.


RESULTS
The sensitivity of inpatient and inpatient plus Part B claims for the corresponding cancer diagnosis was 77.4% and 91.2%, respectively. The sensitivity of inpatient claims alone was highest for colorectal (86.1%) and endometrial (84.1%) cancer and lowest for prostate cancer (63.6%). However, when Part B claims were included, the sensitivity for diagnosis of breast cancer was greater than for other cancers (93.6%). Inpatient claim sensitivity was highest for earlier years of the study, and, because of more complete data and longer follow up, the highest sensitivity of combined inpatient and Part B claims was achieved in the late 1980s or early 1990s.


CONCLUSIONS
Medicare claims provide reasonably high sensitivity for the detection of cancer in the elderly, especially if inpatient and Part B claims are combined. Because the study did not measure other dimensions of accuracy, such as specificity and predictive value, the potential costs of including false positive cases need to be assessed.
Cooper
G S
GS
Department of Medicine, Case Western Reserve University, Cleveland, OH, USA. gxc12@po.cwru.edu
Yuan
Z
Z
Stange
K C
KC
Dennis
L K
LK
Amini
S B
SB
Rimm
A A
AA
D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data*; D008297:Male; D016345:Medicare Part B / Q000706:statistics & numerical data*; D008875:Middle Aged; D009369:Neoplasms / Q000145:classification* / Q000191:economics; D018426:SEER Program / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D014481:United States