title: Quantification of missing prescriptions in commercial claims databases: results of a cohort study.
abstract: OBJECTIVE
  This study aims to quantify the magnitude of missed dispensings in commercial claims databases.
  
  
  METHODS
  A retrospective cohort study has been used linking PharMetrics, a commercial claims database, to a prescription database (LRx) that captures pharmacy dispensings independently of payment method, including cash transactions. We included adults with dispensings for opioids, diuretics, antiplatelet medications, or anticoagulants. To determine the degree of capture of dispensings, we calculated the number of subjects with the following: (1) same number of dispensings in both databases; (2) at least one dispensing, but not all dispensings, missed in PharMetrics; and (3) all dispensings missing in PharMetrics. Similar analyses were conducted using dispensings as the unit of analysis. To assess whether a dispensing in LRx was in PharMetrics, the dispensing in PharMetrics had to be for the same medication class and within ±7 days in LRx.
  
  
  RESULTS
  A total of 1 426 498 subjects were included. Overall, 68% of subjects had the same number of dispensings in both databases. In 13% of subjects, PharMetrics identified ≥1 dispensing but also missed ≥1 dispensing. In 19% of the subjects, PharMetrics missed all the dispensings. Taking dispensings as the unit of analysis, 25% of the dispensings present in LRx were not captured in PharMetrics. These patterns were similar across all four classes of medications. Of the dispensings missing in PharMetrics, 48% involved a subject who had >1 health insurance plan.
  
  
  CONCLUSIONS
  Commercial claims databases provide an incomplete picture of all prescriptions dispensed to patients. The lack of capture goes beyond cash transactions and potentially introduces substantial misclassification bias. © 2017 The Authors. Pharmacoepidemiology & Drug Safety Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Epidemiology, Janssen Research and Development, LLC, Titusville, NJ, USA.
authors.forename: Maria Soledad
authors.initials: MS
authors.lastname: Cepeda
authors.affiliation: Department of Epidemiology, Janssen Research and Development, LLC, Titusville, NJ, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Fife
authors.affiliation: IMS Real World Evidence Solutions, Plymouth Meeting, PA, USA.
authors.forename: Michel
authors.initials: M
authors.lastname: Denarié
authors.affiliation: IMS Real World Evidence Solutions, Plymouth Meeting, PA, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Bradford
authors.affiliation: IMS Real World Evidence Solutions, Plymouth Meeting, PA, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Roy
authors.affiliation: IMS Real World Evidence Solutions, Plymouth Meeting, PA, USA.
authors.forename: Yingli
authors.initials: Y
authors.lastname: Yuan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015982:Bias; D015331:Cohort Studies; D016208:Databases, Factual / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010593:Pharmaceutical Services / Q000706:statistics & numerical data*; D017891:Pharmacoepidemiology / Q000379:methods; D055553:Prescription Drugs / Q000008:administration & dosage*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D055553:Prescription Drugs
keywords: claims databases; limitations of observational studies; misclassification of exposure; pharmacoepidemiology