1. Using machine learning to predict risk of incident opioid use disorder among fee-for-service Medicare beneficiaries: A prognostic study
- Author
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Wei-Hsuan Lo-Ciganic, Walid F. Gellad, Hao Helen Zhang, Gerald Cochran, James L. Huang, Courtney C. Kuza, Jeremy C. Weiss, Adam J. Gordon, C. Kent Kwoh, Julie M. Donohue, and Daniel C. Malone
- Subjects
Male ,Social Sciences ,030204 cardiovascular system & hematology ,Proxy (climate) ,Decile ,Machine Learning ,0302 clinical medicine ,Primary outcome ,Mathematical and Statistical Techniques ,Cognition ,Learning and Memory ,Medicine and Health Sciences ,030212 general & internal medicine ,Fee-for-service ,Analgesics ,Multidisciplinary ,Applied Mathematics ,Simulation and Modeling ,Statistics ,Medicare beneficiary ,Drugs ,Opioid use disorder ,Fee-for-Service Plans ,Middle Aged ,Prognosis ,Physical Sciences ,Memory Recall ,Medicine ,Female ,Algorithms ,medicine.drug ,Research Article ,Computer and Information Sciences ,Neural Networks ,Political Science ,Science ,Public Policy ,Research and Analysis Methods ,Medicare ,Risk Assessment ,03 medical and health sciences ,Artificial Intelligence ,Diagnostic Medicine ,Memory ,medicine ,Pain Management ,Humans ,Statistical Methods ,Aged ,Pharmacology ,business.industry ,Biology and Life Sciences ,Computational Biology ,medicine.disease ,Opioid-Related Disorders ,United States ,Opioids ,Cognitive Science ,business ,Mathematics ,Buprenorphine ,Demography ,Methadone ,Forecasting ,Neuroscience - Abstract
ObjectiveTo develop and validate a machine-learning algorithm to improve prediction of incident OUD diagnosis among Medicare beneficiaries with ≥1 opioid prescriptions.MethodsThis prognostic study included 361,527 fee-for-service Medicare beneficiaries, without cancer, filling ≥1 opioid prescriptions from 2011-2016. We randomly divided beneficiaries into training, testing, and validation samples. We measured 269 potential predictors including socio-demographics, health status, patterns of opioid use, and provider-level and regional-level factors in 3-month periods, starting from three months before initiating opioids until development of OUD, loss of follow-up or end of 2016. The primary outcome was a recorded OUD diagnosis or initiating methadone or buprenorphine for OUD as proxy of incident OUD. We applied elastic net, random forests, gradient boosting machine, and deep neural network to predict OUD in the subsequent three months. We assessed prediction performance using C-statistics and other metrics (e.g., number needed to evaluate to identify an individual with OUD [NNE]). Beneficiaries were stratified into subgroups by risk-score decile.ResultsThe training (n = 120,474), testing (n = 120,556), and validation (n = 120,497) samples had similar characteristics (age ≥65 years = 81.1%; female = 61.3%; white = 83.5%; with disability eligibility = 25.5%; 1.5% had incident OUD). In the validation sample, the four approaches had similar prediction performances (C-statistic ranged from 0.874 to 0.882); elastic net required the fewest predictors (n = 48). Using the elastic net algorithm, individuals in the top decile of risk (15.8% [n = 19,047] of validation cohort) had a positive predictive value of 0.96%, negative predictive value of 99.7%, and NNE of 104. Nearly 70% of individuals with incident OUD were in the top two deciles (n = 37,078), having highest incident OUD (36 to 301 per 10,000 beneficiaries). Individuals in the bottom eight deciles (n = 83,419) had minimal incident OUD (3 to 28 per 10,000).ConclusionsMachine-learning algorithms improve risk prediction and risk stratification of incident OUD in Medicare beneficiaries.
- Published
- 2020