Adaptability of High Dimensional Propensity Score Procedure in the Transition from ICD-9 to ICD-10 in the US Healthcare System.

Background

High-Dimensional Propensity Score procedure (HDPS) is a data-driven approach to assist control for confounding in pharmacoepidemiologic research. The transition to the International Classification of Disease (ICD-9/10) in the US health system may pose uncertainty in applying the HDPS procedure.

Methods

We assembled a base cohort of patients in MarketScan

Results

A similar bias reduction was observed in cohorts where patient selection pattern from each ICD era was comparable between the exposure groups. In the presence of considerable disparity in patient selection, we observed a bimodal distribution of propensity scores in the data dimensions strategy, indicating instrument-like covariates. Moreover, the CCS mapping strategy resulted in at least 30% less bias than pooled RR and data dimensions strategies (RMSE: 0.14, 0.19, 0.21, respectively) in this scenario.

Conclusion

Mapping ICD codes to a stable terminology like CCS serves as a helpful strategy to reduce residual bias when deploying HDPS in pharmacoepidemiologic studies spanning both ICD eras.

Informations de copyright

© 2023 Sarayani et al.

Déclaration de conflit d'intérêts

Almut Winterstein has received funding from the FDA, NIH, PCORI, AHRQ, the Bill and Melinda Gates Foundation, Merck & Co. and the state of Florida. She has received consulting honoraria from Arbor Pharmaceuticals and Genentech. She is a special government employee of the FDA and has served as the Chair of the Drug Safety and Risk Management (DSaRM) Advisory Committee from 2012 to 2018. None is related to this project or poses a conflict of interest. Christian Hampp is employed by Regeneron Pharmaceuticals, Inc., and owns company stock. Regeneron did not provide study funding, does not hold a marketing license for any of the study drugs, and had no role in manuscript development and decision to publish. Amir Sarayani is currently affiliated with Janssen Research & Development LLC. The study conceptualization, conduct, and manuscript writing were part of his doctoral dissertation and completed before his new role. Dr Joshua D Brown reports employment from Pfizer, outside the submitted work. The authors report no other conflicts of interest in this work.