Early steps in the development of a claims-based targeted healthcare safety monitoring system and application to three empirical examples.

Abstract:

BACKGROUND:Several efforts are under way to develop and test methods for prospective drug safety monitoring using large, electronic claims databases. Prospective monitoring systems must incorporate signalling algorithms and techniques to mitigate confounding in order to minimize false positive and false negative signals due to chance and bias. OBJECTIVE:The aim of the study was to describe a prototypical targeted active safety monitoring system and apply the framework to three empirical examples. METHODS:We performed sequential, targeted safety monitoring in three known drug/adverse event (AE) pairs: (i) paroxetine/upper gastrointestinal (UGI) bleed; (ii) lisinopril/angioedema; (iii) ciprofloxacin/Achilles tendon rupture (ATR). Data on new users of the drugs of interest were extracted from the HealthCore Integrated Research Database. New users were matched by propensity score to new users of comparator drugs in each example. Analyses were conducted sequentially to emulate prospective monitoring. Two signalling rules--a maximum sequential probability ratio test and an effect estimate-based approach--were applied to sequential, matched cohorts to identify signals within the system. RESULTS:Signals were identified for all three examples: paroxetine/UGI bleed in the seventh monitoring cycle, within 2 calendar years of sequential data; lisinopril/angioedema in the second cycle, within the first monitoring year; ciprofloxacin/ATR in the tenth cycle, within the fifth year. CONCLUSION:In this proof of concept, our targeted, active monitoring system provides an alternative to systems currently in the literature. Our system employs a sequential, propensity score-matched framework and signalling rules for prospective drug safety monitoring and identified signals for all three adverse drug reactions evaluated.

journal_name

Drug Saf

journal_title

Drug safety

authors

Wahl PM,Gagne JJ,Wasser TE,Eisenberg DF,Rodgers JK,Daniel GW,Wilson M,Schneeweiss S,Rassen JA,Patrick AR,Avorn J,Bohn RL

doi

10.2165/11594770-000000000-00000

subject

Has Abstract

pub_date

2012-05-01 00:00:00

pages

407-16

issue

5

eissn

0114-5916

issn

1179-1942

journal_volume

35

pub_type

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