Djibo DA, Margulis AV, McMahill-Walraven CN, Saltus C, Shuminski P, Kaye JA, Johannes C, Caligaert B, Libertin M, Graham S. Performance of endometrial cancer case finding algorithms among women with select comorbidities in US claims data. Poster presented at the 2022 North American Menopause Society Meeting; October 13, 2022. Atlanta, GA.

OBJECTIVE: Although an algorithm to identify cases of endometrial cancer in insurance claims using International Classification of Disease version 9 Clinical Modification (ICD-9-CM) codes has been published, no such algorithm has been ascertained for ICD10-CM codes. The objective of this stidy was to determine the overall positive predictive value (PPV) of an endometrial cancer case identification algorithm using ICD-10-CM diagnosis codes and among women having type 1 or type 2 diabetes mellitus (DM), obesity, or endometrial hyperplasia.

DESIGN: Study population consisted of women aged ≥ 50 years without prior hysterectomy or endometrial ablation, with at least 12 months enrollment in a health plan prior to diagnosis of endometrial cancer from 2016 through 2020. The algorithm variant A used diagnostic codes for malignant neoplasms of uterine sites (C54.x), excluding C54.2 (malignant neoplasm of myometrium), the algorithm variant B used C54.1 (malignant neoplasm of endometrium) only. Both variants require at least 1 inpatient or 2 outpatient diagnoses (on different dates, separated by any interval). A random subsample of provisional cases was adjudicated via review of medical records as confirmed, probable, possible cases, or non-cases. Agreement in case determination among adjudicators was measured using the kappa coefficient (κ). We estimated the PPV of each variant of the case finding algorithm with exact 95% confidence intervals (CI).

RESULTS: Of 3,143 provisional cases identified by algorithm variant A, medical records for 294 unique provisional cases were obtained and adjudicated; 288 of the 294 also were provisional cases per algorithm variant B. Among the women with a provisional case (n=294), the median age was 69.0 years (25th and 75th percentiles: 63.0, 74.0) years. Among those, 49.0% were obese, 42.5% had type 1 or type 2 DM, and 27.6% had endometrial hyperplasia. Both variants identified the same confirmed cases (n=223), but differed in identification of non-cases, and possible cases. There was high level of agreement between adjudicators, κ=0.78. The overall PPV (95% CI) was 84.2% (79.2%-88.3%) for variant A and 85.8% (80.9%-89.8%) for variant B. Among obese women, PPV was 90.9% (84.7%, 95.2%) for both algorithm variants. Among women with DM, PPV was 85.7% (77.8%, 91.6%) for variant A and 87.3% (79.6%, 92.9%) for variant B. Predictive values were highest among those with endometrial hyperplasia: PPV was 96.1% (88.8%, 99.2%) for variant A and 96.0% (88.9%, 99.2%) for variant B.

CONCLUSION: Based on these results, both variants of the ICD-10-CM case finding algorithm were successful in the identification of true endometrial cancer cases. Algorithm variant B identified fewer provisional cases not determined to be true positive cases than variant A.

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