title: Corroboration of claims algorithm for second-line costs of metastatic colorectal cancer treatment with targeted agents.
abstract: OBJECTIVE
  To refine a claims algorithm for identifying second-line systemic regimens for metastatic colorectal cancer (mCRC) based on clinical evidence and to compare costs during second-line treatment by targeted therapy administered.
  
  
  METHODS
  This retrospective analysis of a large US managed care database identified patients diagnosed with mCRC during 1 July 2007-30 June 2011. A claims-based algorithm was developed to identify patients with at least two lines of therapy (LOT) and the second LOT contained one targeted agent: bevacizumab or any anti-epidermal growth factor receptor (EGFR). Medical chart data from 92 patients were used to corroborate and refine the LOT algorithm. The positive predictive value (PPV) of the initial algorithm and refined algorithm for identification of second LOT are presented. The final algorithm was applied to claims data and two mutually exclusive second-line cohorts were examined: patients with bevacizumab- or cetuximab-containing regimens. Second-line healthcare costs were analyzed with generalized linear models adjusted for demographic and clinical characteristics.
  
  
  RESULTS
  The PPV increased from 50.0% (95% CI = 39.4-60.6) for the initial algorithm to 72.1% (95% CI = 59.2-82.9) for the final algorithm. Mean age in the cohorts (n = 569) was 61 years; 58% were men. Days of therapy were similar for the bevacizumab (n = 450) vs cetuximab (n = 119) cohorts, respectively: 131 vs 148 in first LOT and 123 (both cohorts) in second LOT (p ≥ 0.27). Total costs during second-line treatment in the bevacizumab cohort were lower by $12,318 (p = 0.02) and medical costs were lower by $13,809 (p = 0.01). Monthly total and medical costs were lower by $2728 (p = 0.03) and $3133 (p = 0.01), respectively. Results are based on commercially or Medicare-insured patients and may not be generalizable to Medicaid or uninsured patients.
  
  
  CONCLUSIONS
  Corroboration of claim-based algorithms with medical chart data improved algorithm performance. Second-line total and medical costs were lower for mCRC patients treated with bevacizumab compared with cetuximab.
authors.affiliation: OptumInsight, Eden Prairie, MN, USA. stacey.dacostabyfield@optum.com
authors.forename: Stacey
authors.initials: S
authors.lastname: Dacosta Byfield
authors.forename: Elaine
authors.initials: E
authors.lastname: Yu
authors.forename: Robert
authors.initials: R
authors.lastname: Morlock
authors.forename: Dana
authors.initials: D
authors.lastname: Evans
authors.forename: April
authors.initials: A
authors.lastname: Teitelbaum
mesh_terms: D000368:Aged; D000465:Algorithms; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000191:economics* / Q000627:therapeutic use*; D000068258:Bevacizumab; D000068818:Cetuximab; D015179:Colorectal Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D005260:Female; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D066246:ErbB Receptors; D000068818:Cetuximab