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Authentication of Algorithm to Detect Metastases in Men with Prostate Cancer Using ICD-9 Codes
Matthew T Dolan1, Sung Kim1,2,3, Yu-Hsuan Shao2,4
1Department of Radiation Oncology, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA.
Insights
A new algorithm using specific ICD-9 codes accurately detects prostate cancer (PCa) metastasis. This method offers high sensitivity and specificity for identifying metastatic PCa in patient records.
Area of Science:
- Oncology
- Medical Informatics
- Health Services Research
Background:
- Metastasis is a critical outcome for prostate cancer (PCa) patients.
- Current methods for detecting PCa metastasis using claims data are not validated.
- Accurate identification of metastasis is essential for patient management and research.
Purpose of the Study:
- To develop and validate a claims-based algorithm for detecting prostate cancer (PCa) metastasis.
- To utilize International Classification of Diseases, Ninth Revision (ICD-9) codes for accurate metastasis reporting.
- To compare the performance of two distinct ICD-9 code-based algorithms.
Main Methods:
- Reviewed medical records of 300 hospitalized prostate cancer (PCa) patients.
- Established chart review as the gold standard for metastatic PCa presence.
- Compared Algorithm A (ICD-9 codes 198.5, 197.0, 197.7, 198.3) against Algorithm B (ICD-9 code 198.5).
- Calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).
- Assessed agreement using Kappa statistics.
Main Results:
- Algorithm A achieved 95% sensitivity, 100% specificity, 100% PPV, and 98.7% NPV.
- Algorithm B showed 90% sensitivity, 100% specificity, 100% PPV, and 97.5% NPV.
- Agreement rates were 96.8% for Algorithm A and 93.5% for Algorithm B.
Conclusions:
- The algorithm using ICD-9 codes 198.5, 197.0, 197.7, or 198.3 effectively detects prostate cancer (PCa) metastasis.
- This claims-based approach demonstrates high performance metrics (sensitivity, specificity, PPV, NPV).
- The developed algorithm provides a validated tool for identifying PCa metastasis in administrative data.
Background:
Metastasis is a crucial endpoint for patients with prostate cancer (PCa), but currently lacks a validated claims-based algorithm for detection.
Objective:
To develop an algorithm using ICD-9 codes to facilitate accurate reporting of PCa metastases.
Methods:
Medical records from 300 men hospitalized at Robert Wood Johnson University Hospital for PCa were reviewed. Using the presence of metastatic PCa on chart review as the gold standard, two algorithms to detect metastases were compared. Algorithm A used ICD-9 codes 198.5 (bone metastases), 197.0 (lung metastases), 197.7 (liver metastases), or 198.3 (brain and spinal cord metastases) to detect metastases, while algorithm B used only 198.5. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the two algorithms were determined. Kappa statistics were used to measure agreement rates between claim data and chart review.
Results:
Algorithm A demonstrated a sensitivity, specificity, PPV, and NPV of 95%, 100%, 100%, and 98.7%, respectively. Corresponding numbers for algorithm B were 90%, 100%, 100%, and 97.5%, respectively. The agreement rate is 96.8% for algorithm A and 93.5% for algorithm B.
Conclusions:
Using ICD-9 codes 198.5, 197.0, 197.7, or 198.3 in detecting the presence of PCa metastases offers a high sensitivity, specificity, PPV, and NPV value.
