Evaluation of Enteral Stent Placement Using Claims Data

描述（由申请人提供）：晚期癌症通常表现为十二指肠或大肠梗阻。在过去的几年里，支架置入术已经成功地解除了梗阻，但关于结果的数据有限，几乎没有关于成本的信息。如果支架植入确实提供了更好的结果，那么这应该是一种提供给更多患者的治疗方式，从而显著改善终末期癌症患者的生活质量。长期目标是使用索赔数据对支架与替代治疗的结局和成本效益进行全面比较。2001年，为肠内支架置入建立了几个新的CPT-4代码，因此可以使用索赔跟踪这些患者。在开始本研究之前，提出了一项探索性分析，有两个具体目标：（i）分析支架置入的采用情况并描述新技术的用户特征，以及（ii）评估索赔数据的质量和足够样本量的可用性，以进行支架结局和成本效益的比较分析。本研究的分析文件将根据5% Medicare标准分析文件（SAF）、医生/供应商程序主文件（PSPSF）和SEER-Medicare链接数据构建。将合并住院患者、门诊患者和医生SAF进行分析。将对服务地点、地理分布、医生专业和患者特征进行详细评估。将通过推导一致率（定义为A部分和B部分声明的程序）和记录关键变量的缺失值来测试声明数据的质量。初步评价将提供有关肠内支架的分销和使用的有价值信息，以建立未来采用模式分析的基线数据，并计划成功执行成本效益分析。

DESCRIPTION (provided by applicant): Advanced cancer often presents as obstruction of the duodenum or large bowel. Stent placements to relieve the obstruction have been successfully performed in the past few years but there is only limited data on outcomes and almost no information on cost. If stenting does provide better outcomes then this should be a treatment modality that is offered to more patients, resulting in significant improvement in quality of life of end-stage cancer patients. The long-term objective is to perform a comprehensive comparison of the outcomes and cost-effectiveness of stents versus alternative treatments using claims data. In 2001, several new CPT-4 codes were established for enteral stent placements and therefore it is possible to track these patients using claims. Prior to initiating this study, an exploratory analysis is proposed with two specific objectives: (i) analyze adoption of stent placements and characterize users of the new technology, and (ii) assess the quality of claims data and the availability of adequate sample size to perform comparative analysis of the outcomes and cost-effectiveness of stents. Analytic files for this study will be constructed from the 5% Medicare Standard Analytic Files (SAFs), the Physician/Supplier Procedure Master File (PSPSF) and the SEER-Medicare linked data. The inpatient, outpatient and physician SAFs will be merged to perform the analysis. Detailed evaluation of the site of service, geographic distribution, physician specialty, and patient characteristics will be performed. Quality of claims data will be tested by deriving the rate of concordance, which is defined as procedures with both Part A and Part B claims, and by documenting missing values for key variables. The initial evaluation will provide valuable information on distribution and use of enteral stents to establish baseline data for future analysis on patterns of adoption and plan for successful execution of cost effectiveness analysis.