Accuracy of pharmacy and coded-diagnosis information in identifying tuberculosis in patients with rheumatoid arthritis.

Fiske CT, Griffin MR, Mitchel E, Sterling TR, Grijalva CG
Pharmacoepidemiol Drug Saf. 2012 21 (6): 666-9

PMID: 22532509 · PMCID: PMC3371104 · DOI:10.1002/pds.3243

PURPOSE - Previous studies suggest that disease-modifying anti-rheumatic drugs (DMARDs) increase tuberculosis (TB) risk. The accuracy of pharmacy and coded-diagnosis information to identify persons with TB is unclear.

METHODS - Within a cohort of rheumatoid arthritis (RA) patients (2000-2005) enrolled in Tennessee Medicaid, we identified those with potential TB using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD9-CM) diagnosis codes and/or pharmacy claims. Using the Tennessee TB registry as the gold standard for identification of TB, we estimated the sensitivity, specificity, predictive values, and the respective 95% confidence intervals for each TB case-ascertainment strategy.

RESULTS - Ten of 18,094 RA patients had confirmed TB during 61,461 person-years of follow-up (16.3 per 100,000 person-years). The sensitivity and positive predictive value (PPV) and respective 95% confidence intervals were low for confirmed TB based on ICD9-CM codes alone (60.0% (26.2-87.8) and 1.3% (0.5-2.9)), pharmacy data alone (20% (2.5-55.6) and 4.1% (0.5-14.3)), and both (20% (2.5-55.6) and 25.0% (3.2-65.1)).

CONCLUSIONS - Algorithms that use administrative data alone to identify TB have a poor PPV that results in a high false positive rate of TB detection.

Copyright © 2012 John Wiley & Sons, Ltd.

MeSH Terms (16)

Antirheumatic Agents Antitubercular Agents Arthritis, Rheumatoid Cohort Studies Community Pharmacy Services Drug Utilization Review Humans Incidence Insurance Claim Review International Classification of Diseases Medicaid Predictive Value of Tests Sensitivity and Specificity Tennessee Tuberculosis United States

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