Can administrative data be used to measure chemotherapy side effects?

Abstract

Many of the issues with using data from clinical trials and observational studies for economic evaluations are highlighted in the case of chemotherapy side effects. We present the results of an observational cohort study using linked administrative data. The chemotherapy side effects identified in the administrative data are compared with patient self-reports of such events. The results of these comparisons are then used to guide a discussion of the issues surrounding the use of administrative data to identify clinical events for the population of economic models. Although the advantages of easy access and generalizability of the results make administrative data an attractive option for populating economic models, this is not always possible because of the limitations of these data.

Keywords:

• cancer
• chemotherapy
• clinical trials
• economic evaluation
• observational data

Acknowledgements

The authors thank the participants of the Elements of Cancer Care study and EMCaP Project Investigators J Hall, M Faedo and C Harris for their support.

Financial & competing interests disclosure

A Pearce was supported by the University of Technology, Sydney Doctoral Scholarship, and a PhD top-up scholarship within an NHMRC Health Services Research Grant (ID455366) through the Centre for Health Economics Research and Evaluation. Neither funding organization had any role in the study. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Economic evaluations are an increasingly important component in health policy making, particularly in the field of oncology where the costs of new anti-cancer treatments are increasing.

• Although randomized controlled trials are the gold standard to determine efficacy and effectiveness of new medical treatments, they often do not reflect clinical practice, with the incidence and costs of side effects often under-reported. This means clinical trial data may not accurately capture health outcomes and/or health care resource use.

• Using administrative data generated in routine clinical care to populate economic models may improve the external validity of economic evaluations, thus enhancing subsequent decision making. However, this analysis found poor congruence between chemotherapy side effects data identified in administrative data using a proxy measure and self-reported chemotherapy side effects.

• Administrative data could be a useful method to capture many health system costs for estimating resource use associated with side effects for economic evaluations. However, the patient perspective may not be accounted for in administrative data, which may result in underestimation of impacts on patient outcomes such as quality of life and persistence with chemotherapy.