Using medication utilization information to develop an asthma severity classification model
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Abstract
[[abstract]]Background: Claims data are currently widely used as source data in asthma studies. However, the insufficient
information in claims data related to level of asthma severity may negatively impact study findings. The present
study develops and validates an asthma severity classification model that uses medication utilization in Taiwan
National Health Insurance claims data.
Methods: The National Health Insurance Research Database was used for the years 2006–2012 and included a total
of 7221 patients newly diagnosed with asthma in 2007 for model development and in 2008 for model validation.
The medication utilization of patients during the first year after the index date was used to classify level of severity, and
the acute exacerbation of asthma during the second through fourth years after the index date was used as the
outcome variable. Three models were developed, with subjects classified into four, three, and two groups, respectively.
The area under the receiver operating characteristic curve (AUC) and the Kaplan-Meier survival curve were used to
compare the performances of the classification models.
Results: In development data, the distribution of subjects and acute exacerbation rate among the stage 1 to stage 4
were: 62.71%, 5.54%, 22.79%, and 8.96%, and 8.17%, 9.55%, 11.97%, and 14.91%, respectively. The results also showed
the higher severity groups to be more prone to being prescribed oral corticosteroids for asthma control, while lower
severity groups were more likely to be prescribed short-acting medication and inhaled corticosteroid treatment.
Furthermore, the results of survival analysis showed two-group classification was recommended and yield moderate
performance (AUC = 0.671). In validation data, the distribution of subjects, acute exacerbation rates, and medication
uses among stages were similar to those in development data, and the results of survival analysis were also the same.
Conclusions: Understanding asthma severity is critical to conducting effective, scholarly research on asthma, which
currently uses claims data as a primary data source. The model developed in the present study not only overcomes a
gap in the current literature but also provides an opportunity to improve the validity and quality of claims-data-based
asthma studies