Contributions
Abstract: EP1767
Type: ePoster
Abstract Category: Therapy - disease modifying - 30 Tools for detecting therapeutic response
Background: Although the demand for observational studies in multiple sclerosis (MS) using real-world data has grown in recent years, administrative codes such as ICD-9-CM do not exist for results of clinical assessment instruments such as the Kurtzke Functional Systems Scores (KFSS). The ability to measure KFSS in healthcare claims databases will improve the capacity to perform comparative effectiveness and safety of medical products studies.
Objectives: To map the components of the KFSS to ICD-9-CM codes for identifying MS patients with disease progression and quantifying MS severity.
Methods: The KFSS include pyramidal, cerebellar, brainstem, sensory, bowel and bladder, visual, and cerebral (or mental) components. As ICD-9-CM does not have all of the exact codes for KFSS signs and symptoms within each system, cross-mapping was performed as close as possible by an experienced clinician and reviewed by clinical informaticists. 'Unknown' (value=9) was not mapped for the KFSS. 'Normal' (value=0) was defined by an absence of a sign or symptom. From the assigned ICD-9-CM code list for KFSS, it was possible to generate Kurtzke Expanded Disability Status Scale (EDSS) scores for patients and to assess disease progression over time. Disease progression was defined by change between the first recorded EDSS score during the first 7th -12th months of care coverage and the EDSS score during the 1st -6th months of the patient's most recent 1-year period of care coverage. Change was required to be ≥ 1.0 point if the baseline EDSS score was between 0 and 5 inclusive, or ≥ 0.5 point if the baseline EDSS score was ≥5.5.
Results: From a cohort of 2,960 MS patients, 608 (20.5%) were identified as progressive MS by change in EDSS score. Among these 608 patients, the mean first and second EDSS scores were 0.49 and 4.74. Median (range) first and second EDSS scores were 0 (0-6) and 5 (1-8), respectively. The mean change from the first to second EDSS score was 4.25, while the median was 5 (1 to 7.5). The median KFSS first score for all systems was 0. The mean KFSS first score varied by system, with the highest (1.06) for sensory function and lowest (0.12) for cerebellar functions.
Conclusions: Mapping of KFSS using ICD-9-CM can be used to calculate change in EDSS score and identify patients with MS disease progression. Progressive MS patients had a wide range of EDSS score changes with a median increase of 5 during their final year of coverage in the IDN.
Disclosure: This study was funded by Merck KGaA.
- Chi Thi Le Truong is an employee of MedCodeWorld.
- Hoa Van Le is an employee of PAREXEL and a stockholder of GlaxoSmithKline, and was a Harry Guess-Merck merit scholarship recipient.
- John R. Holmen has nothing to disclose.
- Christopher L. Fillmore has nothing to disclose.
- Aaron W.C. Kamauu received a research grant from Merck KGaA.
- Monica G. Kobayashi is an employee of PAREXEL.
- Meritxell Sabidó-Espin is an employee of Merck KGaA.
- Schiffon L. Wong is an employee EMD Serono.
Abstract: EP1767
Type: ePoster
Abstract Category: Therapy - disease modifying - 30 Tools for detecting therapeutic response
Background: Although the demand for observational studies in multiple sclerosis (MS) using real-world data has grown in recent years, administrative codes such as ICD-9-CM do not exist for results of clinical assessment instruments such as the Kurtzke Functional Systems Scores (KFSS). The ability to measure KFSS in healthcare claims databases will improve the capacity to perform comparative effectiveness and safety of medical products studies.
Objectives: To map the components of the KFSS to ICD-9-CM codes for identifying MS patients with disease progression and quantifying MS severity.
Methods: The KFSS include pyramidal, cerebellar, brainstem, sensory, bowel and bladder, visual, and cerebral (or mental) components. As ICD-9-CM does not have all of the exact codes for KFSS signs and symptoms within each system, cross-mapping was performed as close as possible by an experienced clinician and reviewed by clinical informaticists. 'Unknown' (value=9) was not mapped for the KFSS. 'Normal' (value=0) was defined by an absence of a sign or symptom. From the assigned ICD-9-CM code list for KFSS, it was possible to generate Kurtzke Expanded Disability Status Scale (EDSS) scores for patients and to assess disease progression over time. Disease progression was defined by change between the first recorded EDSS score during the first 7th -12th months of care coverage and the EDSS score during the 1st -6th months of the patient's most recent 1-year period of care coverage. Change was required to be ≥ 1.0 point if the baseline EDSS score was between 0 and 5 inclusive, or ≥ 0.5 point if the baseline EDSS score was ≥5.5.
Results: From a cohort of 2,960 MS patients, 608 (20.5%) were identified as progressive MS by change in EDSS score. Among these 608 patients, the mean first and second EDSS scores were 0.49 and 4.74. Median (range) first and second EDSS scores were 0 (0-6) and 5 (1-8), respectively. The mean change from the first to second EDSS score was 4.25, while the median was 5 (1 to 7.5). The median KFSS first score for all systems was 0. The mean KFSS first score varied by system, with the highest (1.06) for sensory function and lowest (0.12) for cerebellar functions.
Conclusions: Mapping of KFSS using ICD-9-CM can be used to calculate change in EDSS score and identify patients with MS disease progression. Progressive MS patients had a wide range of EDSS score changes with a median increase of 5 during their final year of coverage in the IDN.
Disclosure: This study was funded by Merck KGaA.
- Chi Thi Le Truong is an employee of MedCodeWorld.
- Hoa Van Le is an employee of PAREXEL and a stockholder of GlaxoSmithKline, and was a Harry Guess-Merck merit scholarship recipient.
- John R. Holmen has nothing to disclose.
- Christopher L. Fillmore has nothing to disclose.
- Aaron W.C. Kamauu received a research grant from Merck KGaA.
- Monica G. Kobayashi is an employee of PAREXEL.
- Meritxell Sabidó-Espin is an employee of Merck KGaA.
- Schiffon L. Wong is an employee EMD Serono.