Concordance of opioid exposure in all-payer claims databases with prescription drug monitoring program database using Arkansas as a case example

Objective: To assess the concordance between and benefit of adding prescription drug monitoring program (PDMP) data to all-payer claims database (APCD) data for identifying and classifying opioid exposure among insured individuals. Data Sources and Study Setting: Arkansas APCD and PDMP. Study Design: Enrollees in APCD were classified as (1) true positives: if they received opioids in both databases, (2) false positives: if they only received opioids in APCD, (3) true negatives: if they had no opioid exposure in both databases, (4) false negatives: if they only received opioids in the PDMP database. Specificity, sensitivity, negative, and positive predictive values were calculated using PDMP as the 'gold standard' database source. Subjects were also categorized as those who received any opioid, chronic opioid, high-dose opioid, or high-risk opioid therapies. Data Collection/Extraction Methods: Arkansas residents continuously enrolled with pharmacy coverage in 2016 were included. APCD and PDMP were linked using an encrypted enrollee identifier, gender, and year of birth. Principal Findings: The degree of concordance in opioid exposure between the two databases among 1,411,565 enrollees was high (sensitivity = 92.67%, specificity = 96.13%, positive predictive value = 91.60%, negative predictive value = 96.65%). Enrollees classified as having any opioid (APCD: 31.64% vs. PDMP: 31.26% vs. APCD +PDMP: 33.93%), chronic opioid (APCD: 7.81% vs. PDMP: 7.54% vs. APCD+PDMP: 8.24%), high-dose opioid (APCD: 10.60% vs. PDMP: 9.62% vs. APCD+PDMP: 11.33%), or high-risk opioid (APCD: 5.28% vs. PDMP: 5.33% vs. APCD+PDMP: 6.20%) therapies, were similar using only APCD versus PDMP versus the combined APCD and PDMP data sources. Conclusions: Claims data sources, such as APCDs, are fairly accurate in identifying opioid exposure and the level of opioid exposure among persons with continuous pharmacy coverage. KEYWORDS administrative claims data, all-payer claims database, opioid therapy, pharmacoepidemiology, prescription drug monitoring program What is known on this topic * Health care claims data are frequently used for pharmacoepidemiology research of opioids. * Prescription Drug Monitoring Programs (PDMPs) are a secondary data resource used to inform state-level initiatives in combatting the opioid epidemic. * All-Payer Claims Databases (APCDs) were created to Improve quality and mitigate costs within health care systems. APCDs capture health insurance claims from nearly all health care payers in each state. What this study adds * The sensitivity, specificity, and positive and negative predictive values of opioid prescription claims data are high when compared to a 'gold standard' prescription drug monitoring program data. * Claims data alone are fairly accurate in classifying enrollees according to the level/risk of opioid therapy. * Opioid prescription claims are fairly accurate in classifying opioid therapy exposure in population-level analyses.
1 | INTRODUCTION The rise in opioid overdoses and the number of persons struggling with opioid use disorder (OUD) is a public health crisis. (12) In 2019, close to 1.6 [...]