reg acos working group meeting 25/09/15

2015 ERS EVENTS

DATE: FRIDAY SEPTEMBER 25TH

VENUE: Wyndham Apollo Hotel, AmsterdamROOM: BoardroomTIME: 9:00-10.30AM

CHAIR: Jerry A. Krishnan, Professor of Medicine and Public Health & Associate Vice President for Population Health Sciences, University of Illinois Hospital & Health Sciences System, Chicago, Illinois, USA

ACOS WORKING GROUP MEETING

Agenda (revised)

• Welcome / introductions (Jerry)• Proof of concept study design (Jerry)• Available datasets (Alison)• OPCRD Pilot Data as use case (Alison /

Victoria)• Next steps / alignment between WG

Members and Supporting Collaborators (David)

FINALISATION & SIGN-OFF OF THE REG ACOS WORKING GROUP STUDY PROTOCOL

Stage 1: Proof of Concept (POC) study

http://www.bing.com/images/search?q=less+than+or+equal+to+symbol+&id=2F5504D1E03B9C4D9CBAA2CF7B5F1B70F6E6C8B0&FORM=IQFRBA

Background / rationale

• 2014, GINA and GOLD published their first joint statement on Asthma-COPD Overlap Syndrome (ACOS)1

• Various criteria for diagnosis of ACOS have been proposed2-4

• The lack of a gold standard definition is a barrier to ACOS research, i.e. to understanding the biology of the condition and to exploring optimum management approaches.5

1. GINA-GOLD Diagnosis of disease of chronic airflow limitation: Asthma, COPD and asthma-COPD overlap syndrome (ACOS), 20142. Miravitlles M, et al. Arch Bronconeumol 20143. Koblizek V, et al. Pap Med Fac Univ Palacky Olomouc Czech Repub 20134. Kankaanranta H, et al. Basic Clin Pharmacol Toxicol. 20155. Postma DS, Rabe KF. NEJM 2015

Ambiguity is a barrier to progress

Postma D, Rabe K. NEJM 2015

January 2012 to December 2012ATS Multiple Chronic Conditions Workshop, 2014

Medicare administrative claims, United States, 2012

(mostly due to disability claim) % %Asthma prevalence 7.4 Asthma prevalence 4.3Top 10 co-morbidities Top 10 co-morbidities

Hypertension 64.5 Hypertension 80.6Depression 50.9 Hyperlipidemia 64.0Hyperlipidemia 47.0 Arthritis (RA/OA) 50.2Arthritis (RA/OA) 42.8 Ischemic Heart Disease 47.3Diabetes 40.7 COPD 42.1COPD 34.9 Anemia 41.5Anemia 34.9 Diabetes 38.6Ischemic Heart Disease 30.2 Heart Failure 32.7Heart Failure 21.3 Chronic Kidney Disease 27.4Chronic Kidney Disease 20.0 Depression 25.5

Notes:Prepared by CMS/OIPDA on October 6, 2014.

Beneficiaries 65 years and older (N = 1,197,869)Beneficiaries less than 65 years (N = 462,346)

Data Source: CMS administrative claims data, January 2012- December 2012, from the Chronic Condition Warehouse (CCW), ccwdata.org.

Beneficiaries 65 years and older (N =3,161,723)% %

COPD prevalence 11.0 COPD prevalence 11.3Top 10 co-morbidities Top 10 co-morbidities

Hypertension 70.7 Hypertension 81.4Hyperlipidemia 52.3 Hyperlipidemia 61.3Depression 47.3 Ischemic Heart Disease 57.6Ischemic Heart Disease 42.8 Anemia 45.4Diabetes 42.5 Arthritis (RA/OA) 44.1Arthritis (RA/OA) 42.3 Heart Failure 42.7Anemia 36.3 Diabetes 38.6Heart Failure 30.3 Chronic Kidney Disease 34.3Chronic Kidney Disease 24.7 Depression 26.6Asthma 23.4 Alzheimier's Disease 20.2

Notes:Prepared by CMS/OIPDA on October 6, 2014.

Beneficiaries less than 65 years (N =688,542 )

Data Source: CMS administrative claims data, January 2012- December 2012, from the Chronic Condition Warehouse (CCW), ccwdata.org.

POC study

• To estimate prevalence of ACOS (age, smoking, obstruction, reversibility) in different population series (asthma, COPD, ACOS, neither asthma/COPD)

• To compare results when same ACOS case definition used in different datasets

• Benefits of completing the POC studyo Answer important scientific questionso Assess feasibility of using different datasetso Build relationships for future projects (e.g., more detailed

characterization, response to therapy)

POC design: population definitions

Definition Criterion

Population Series 1: COPD diagnosis

Population Series 2: ACOS diagnosis

Population Series 3: Asthma diagnosis

Population Series 4: No diagnosis of asthma or COPD (“control”)

A B C A B C A B C A B C

Age >40 years Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Smoking* Smoking history ever Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

ObstructionPost BD FEV1/FVC <70%

Ignore Yes Yes Ignore Yes Yes Ignore Yes Yes Ignore Yes Yes

Reversibility

post-BD increase in FEV1 by ≥12% and ≥200mL

Ignore Ignore Yes Ignore Ignore Yes Ignore Ignore Yes Ignore Ignore Yes

Diagnosis

Physician diagnosis, billing “diagnosis”

COPD dx ACOS or asthma & COPD dx Asthma dx

Neither asthma nor COPD nor ACOS dx

*Hx of past or current smoking, or smoking cessation advice

Analysis (I)

Study period – current protocol

• Most recent 12-month characterization periodo Clinical practice (and use of billing codes) evolves over time

Analysis (II)• Prevalence of “ACOS” (age, smoking, obstruction,

reversibility) within different parent populations with asthma or COPD dxo Series 1 (COPD dx): C/A X 100%, C/B X 100%o Series 2 (ACOS dx): C/A X 100%, C/B X 100%o Series 3 (Asthma dx): C/A X 100%, C/B X 100%

• Prevalence of “ACOS” in population without asthma or COPD dxo Series 4 (Control): C/A X 100%, C/B X 100%

• Assess agreement using different case definitions of ACOSo Series 1C vs. 2C vs. 3C vs. 4C (kappa statistic)

WHICH DATABASES WILL BE INCLUDED IN STAGE I OF THE FINAL PROTOCOL…?

Available datasets


Available datasets• Databases for Phase 1 will be limited to population-based or

administrative/billing-based sampling methods to increase the external validity of the study.

• Databases resulting from completed research studies/trials will not be eligible for Phase I, but may be eligible for subsequent phases.

• Information has not been provided for: COBRA (France); COLIBRI (France); INITIATIVES (France); SPIROMICS (USA); CONCERT(USA); COSYCONET (Germany). o As these databases do not contain “random or representative

population samples” they are not be eligible for inclusion in Stage 1

Definition CriterionPopulation Series 1

A B CAge >40 years Yes Yes Yes

Smoking Smoking history ever* Yes Yes Yes

Obstruction Post BD FEV1/FVC <70% Ignore Yes Yes

Reversibilitypost-BD increase in FEV1 by ≥12% and ≥200mL

Ignore Ignore Yes

DiagnosisPhysician diagnosis, billing “diagnosis”

COPD dx

NUMBER OF DATABASES CHARACTERISED 8 8 8

NUMBER OF DATA BASES IN WHICH THE POPULATION IS OPERATIONALIZABLE

8 6 (4 + 2 subsets*) 6 (4 + 2 subsets*)

NAME OF DATABASES IN WHICH THE DEFINTION IS OPERATIONALIZABLE

1. Dutch ASTHMA / COPD Service2. Adelphi Respiratory Disease

Specific Programme3. OPCRD4. HealthCore5. SIDIAP6. MAJORICA7. Market Scan (except smoking*)8. Optum (except smoking)


Specific Programme*3. OPCRD 4. SIDIAP5. MAJORICA6. Healthcore*



“COPD series”

“ACOS series”






Ignore Ignore Yes


ACOS dx or asthma and COPD dx



8 6 (4 + 2 subsets*) 6 (4 + 2 subsets*)








“Asthma series”






Ignore Ignore Yes


Asthma dx



8 6(4 in all patients; 2 subsets*)

6(4 in all patients; 2 subsets*)







Specific Programme*3. OPCRD 4. SIDIAP5. MAJORICA6. Healthcore *

“Control series”






Ignore Ignore Yes


Neither asthma nor COPD nor ACOS



7 5(3 in all patients; 2 in subsets*)

5(3 in all patients; 2 in subsets*)


1. Dutch ASTHMA / COPD Service2. OPCRD3. HealthCore4. SIDIAP5. Market Scan (except smoking)6. Optum (except smoking)7. MAJORICA

1. Dutch ASTHMA / COPD Service2. OPCRD 3. SIDIAP4. Healthcore*5. MAJORICA

1. Dutch ASTHMA / COPD Service2. OPCRD 3. SIDIAP4. Healthcore *5. MAJORICA

Available datasets: summaryDATABASE Time for completion of Stage 1 Cost for completion of Stage 1

1. Dutch ASTHMA / COPD Service 8 weeks EUR 10,000 (~2 months post-doc salary)

2. Adelphi Respiratory Disease Specific Programme ≤ 4 weeks £0

3. Optimum Patient Care Research Database (OPCRD) 4-6 weeks £10,000

4. SIDIAP 6 weeks EUR 1,500

5. MAJORICA TBC TBC

6. PCORnet Common Data Model Data available Sept 2016; analysis estimate ? TBC

7. HealthCore 3 weeks $4,167 (if manual programming required)

8. MarketScan "1 day" ?

9. Optum Humedica "1 day" ?

Which databases should be included in the Protocol?

Available datasets: summaryDATABASE Time for completion of Stage 1 Cost for completion of Stage 1

1. Dutch ASTHMA / COPD Service 8 weeks EUR 10,000 (~2 months post-doc salary)

2. Adelphi Respiratory Disease Specific Programme ≤ 4 weeks £0

3. Optimum Patient Care Research Database (OPCRD) 4-6 weeks £10,000

4. SIDIAP 6 weeks EUR 1,500

5. MAJORICA TBC TBC

6. PCORnet Common Data Model Data available Sept 2016; analysis estimate ? TBC

7. HealthCore 3 weeks $4,167 (if manual programming required)

8. MarketScan "1 day" ?

9. Optum Humedica "1 day" ?

Which databases should be included in the Protocol?

?

✓X Valuable for repeat analysis and validation when available

POC using OPCRD Pilot Data


Methodological approach• Review all patients with ≥2 healthcare contacts in the evaluation year

• Based on coded reason for consultation (where available), categorise as:o COPD Population: ≥2 consultations coded for COPD o Asthma Population: ≥2 consultations coded for asthma o ACOS Population: ≥1 consultation coded for COPD plus ≥1

consultation coded for asthma– Asthma/ACOS: ≥2 consultations for asthma and ≥1 consultation for

COPD– COPD/ACOS: ≥2 consultations for COPD and ≥1 consultation for

asthma

NB. There is no ACOS code in the UK

Degree of overlap & starting numbers

≥2 Asthma Consultations

≥2 COPD Consultations

≥1 Asthma consultation and

≥1 COPD consultationPatients Group(s)

No No No 986,072 NoneNo No Yes 2,254 ACOSNo Yes No 10,938 COPDNo Yes Yes 1,683 COPD/ACOSYes No No 27,462 AsthmaYes No Yes 701 Asthma/ACOS

Yes Yes Yes 750 Asthma/COPD/ACOS

Want to agree the right diagnostic starting point. Thereafter, obstruction, reversibility, smoking and age criteria must be

applied (i.e. total population count numbers will reduce further).

Degree of overlap & starting numbers

OPCRD Pilot Data

Taking a Diagnostic Coding approach


Methodological approach• Diagnosis:

o “Asthma diagnosis, Yes”: patients with an asthma diagnosis ever o “COPD diagnosis, Yes”: patients with an COPD diagnosis ever o “ACOS diagnosis, Yes”: patients who received a diagnosis of asthma and COPD within 12

months of each other, evero “Control diagnosis, Yes”: patients with no asthma or COPD diagnostic code, ever

• Age, obstruction, reversibility, smoking status evaluated during or closest to the 12-month characterization period 1 April 2012–31 March 2013

• Sensitivity analysis:o Patients with ≥2 lower respiratory consultations during the evaluation yearo Why? To show how this reduces (perhaps without clinical “appropriateness”) the number of

eligible patients in a UK clinical data where consultations are often not coded and where asthma patients often only go to the doctor once a year for their asthma review (at most). It possibly also biases the population to be a more severe population in the UK.

Population counts

Criteria Series 1: COPD Series 2: ACOS Series 3: Asthma Series 4: NoneDiagnosis Yes 27,721 8,082 259,712 734,345

Age >= 40>=40 27,575 8,005 126,053 449,334<40 146 77 133,659 285,011missing 0 0 0 0

Smoking History everCurrent or ex-smoker 23,926 6,450 55,680 204,998non-smoker 2,852 1,471 67,480 228,711missing 797 84 2,893 15,625

Definition A 23,926 6,450 55,680 204,998

Obstruction

<0.7 Fev1 percent pred or FeV1/FCV 13,485 4,089 6,397 7,834

>= 0.7 Fev1 percent pred and FeV1/FCV 4,194 1,251 9,157 18,642

Missing 6,247 1,110 40,126 178,522Definition B 13,485 4,089 6,397 7,834

Reversability

≥12% and ≥200 mL increase in FEV1 post-bronchodilator or ≥15% increase in FEV1

222 89 175 258

<12% or 200ml increase 701 170 238 595Missing 12,562 3,830 5,984 6,981

Definition C 222 89 175 258

Population counts with ≥2 consults

Criteria Series 1: COPD Series 2: ACOS Series 3: Asthma Series 4: NoneDiagnosis Yes 27,721 8,082 259,712 734,345

2+ resp consults in year Yes 15,563 5,487 56,858 56,545

Age >= 40>=40 15,505 5,453 35,816 37,307<40 58 34 21,042 19,238missing 0 0 0 0

Smoking History everCurrent or ex-smoker 13,978 4,464 17,310 19,484non-smoker 1,476 974 18,289 17,472missing 51 15 217 351

Definition A 13,978 4,464 17,310 19,484

Obstruction

<0.7 Fev1 percent pred or FeV1/FCV 8,514 2,962 3,398 1,825

>= 0.7 Fev1 percent pred and FeV1/FCV 2,480 868 4,077 4,593

Missing 2,984 634 9,835 13,066Definition B 8,514 2,962 3,398 1,825

Reversability


137 62 77 46

<12% or 200ml increase 414 107 133 136Missing 7,963 2,793 3,188 1,643

Definition C 137 62 77 46

Effect of ≥2 LR consultsCOPD Series ACOS Series Asthma Series Control Series

Criteria

No consult criteria

≥2 LR consults

No consult criteria

≥2 LR consults

No consult criteria

≥2 LR consults

No consult criteria

≥2 LR consults

Diagnosis Yes 27,721 27,721 8,082 8,082 259,712 259,712 734,345 734,345

Respiratory Consultations NA 15,563 NA 5,487 56,858 NA 56,545

Age >= 40>=40 27,575 15,505 8,005 5,453 126,053 35,816 449,334 37,307<40 146 58 77 34 133,659 21,042 285,011 19,238missing 0 0 0 0 0 0 0 0

Smoking History everCurrent or ex-smoker 23,926 13,978 6,450 4,464 55,680 17,310 204,998 19,484non-smoker 2,852 1,476 1,471 974 67,480 18,289 228,711 17,472missing 797 51 84 15 2,893 217 15,625 351

Definition A 23,926 13,978 6,450 4,464 55,680 17,310 204,998 19,484

Obstruction

<0.7 Fev1 percent pred or FeV1/FCV 13,485 8,514 4,089 2,962 6,397 3,398 7,834 1,825

>= 0.7 Fev1 percent pred and FeV1/FCV 4,194 2,480 1,251 868 9,157 4,077 18,642 4,593

Missing 6,247 2,984 1,110 634 40,126 9,835 178,522 13,066Definition B 13,485 8,514 4,089 2,962 6,397 3,398 7,834 1,825

Reversability


222 137 89 62 175 77 258 46

<12% or 200ml increase 701 414 170 107 238 133 595 136

Missing 12,562 7,963 3,830 2,793 5,984 3,188 6,981 1,643Definition C 222 137 89 62 175 77 258 46

Demographics

Clinical characteristics (I)

Clinical characteristics (II)

Question for the protocol…• For a clinical database (where diagnosis does not need to be

inferred from coded consultations but can be identified by physician diagnosis) start from:o Coded consultations oro Diagnosis (ever)

By Consults By prior diagnosis codes

Series 1: COPD 13,371 27,721

Series 2: ACOS 4,687 8,082

Series 3: Asthma 28,913 259,712

Series 4: None 986,072 734,345

Alignment between REG WG ideas & Collaborating Supporter identified needs

Future research goals / needs discussion


Study Design: population definitions

Definition Criterion

Population Series 1: COPD diagnosis

Population Series 2: ACOS diagnosis

Population Series 3: Asthma diagnosis

Population Series 4: No diagnosis of asthma or COPD (“control”)

A B C A B C A B C A B C

Age >40 years Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

Smoking* Smoking history ever Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

ObstructionPost BD FEV1/FVC <70%

Ignore Yes Yes Ignore Yes Yes Ignore Yes Yes Ignore Yes Yes

Reversibility**

post-BD increase in FEV1 by ≥12% and ≥200mL

Ignore Ignore Yes Ignore Ignore Yes Ignore Ignore Yes Ignore Ignore Yes

Diagnosis

Physician diagnosis, billing “diagnosis”

Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No

*History of past or current smoking, or smoking cessation advice

**There is no single definition of acute bronchodilator response. Some of the more commonly used definitions include: 1. ≥12% and ≥200 mL increase in FEV1 post-bronchodilator (GINA and GOLD 2014 ACOS definition; Pelligrino R ,ERS/ATS Task Force, ERJ 2005; ATS Am Rev

Respir Dis 1991; Tashkin D, Chest 2003); 2. ≥15% increase in FEV1 (ACCP, Chest 1974; COMBIVENT study group, Chest 1997); 3. ≥10% absolute increase in FEV1 predicted (Anthonisen NR Am Rev Respir Dis 1986; Eliasson O Am Rev Respir Dis 1985; Brand PL Thorax 1992) Whether or not an individual is classified as having FEV1 reversibility depends on various factors, including the starting FEV1, gender, smoking status, type and dose of bronchodilators, and timing of assessment post-bronchodilator. Using a change in volume or an absolute change in % predicted helps guard against favoring low starting FEV1s in identifying patients with “reversibility.” As there is no clear consensus, we will employ the criteria proposed by the ERS/ATS Task Force and GINA/GOLD ACOS definition documents (i.e. ≥12% and ≥200mL increase post-bronchodilator). Secondary analyses can examine other definitions.

In each diagnostic series (1–4): C is a subset of B, which is a subset of A

Database information: summary (I)DATABASE

Details Provided Type of Sample Country Source of data – Clinical Data (EMR) or Administrative/Billing Data

To establish the "representativeness" of the population within the database

(e.g. selected for trial inclusion; unselective convenience sampling; representative of the population as a whole)

National origin of the patients within the dataset

To indicate whether the data includes direct information about a helathcare encounter (i.e. recorded in their electronic medical records) or indirect information as coded for insurance or

administrative claims purposes

Indication of the ability of each dataset to identify the 12 populations (COPD A–C; Asthma A–C; ACOS A–C and

Control A–C) proposed for revaluation

Dutch ASTHMA / COPD Service

People with respiratory symptoms treated by their GP. With or without inhalation medication. Both

diagnostic and follow up.The Netherlands

Electronic medical record, but not all visits are recorded for other encounters other than the visits to the A/C service

12 of 12

Adelphi Respiratory Disease Specific Programme

Convenience sample of consecutive outpatients visiting their physician (both primary and specialist

care settings)

France, Germany, Italy, Spain, UK, USA,

Japan, China, CanadaElectronic Medical Records

9 of 12• Unable to identify the 3x Control Populations as

survey only includes patients with a asthma or COPD diagnosis

Optimum Patient Care Research Database (OPCRD)

Patients registered at UK primary care practices that receive the Optimum Patient Care Clinical Service. Enriched sample of patients with ≥1 prescription or

diagnosis of obstructive lung disease (as initially only OLD pts received the OPC review)

UK Electronic Medical Records12 of 12

• Only a subgroup of patients will have reversibility data (required to evaluate the 4 x C Populations)

SIDIAP

Records for patients treated by the Catalan Health Institute (CHI) – the chief provider of medical

services in Catalonia. 5,8 million patients (>80% population); 274 Primary Care Centres in Catalonia;

3,400 GPs

Spain (Catalonia Region) Electronic Medical Records 12 of 12

MAJOrca Real-world Investigation in COPD and Asthma database (MAJORICA)

Combined data from the primary care system (e-SIAP), the hospital claims system (FIC), and the

pharmacy database (RELE) in the Balearics, Spain. Covers all health-care utilisation of the permanent inhabitants of the Balearics (≥1.1 million people)

Majorca Electronic medical records 12 of 12 (TBC)

PCORnet Common Data Model

Population-based (anyone with ≥1 healthcare encounter for any reason at contributing healthcare

facilities)USA Electronic Health Records 12 of 12

HealthCore

Automated computerized claims data and enrollment for approximately 51 million lives with at least

medical enrollment, and nearly 33 million lives with medical and pharmacy enrollment information from 14 Blue Cross and/or Blue Shield (BCBS) licensed

plans

USA

Adminsitrative/Billing Data+

linked medical records (from EMR review study)

12 of 12 • All A populations will be identifiable

• All B and C populations (requiring reversibility and obstruction data) will only be identifieable in those

with linked claims + chart review data

MarketScan Commercial, Medicare Supplemental, and Medicaid contain >200 million patients since 1995. USA Adminsitrative/Billing Data

4 of 12• Only group A can be evaluated and only based on codes for smoking cessation (i.e. no smoking code, but inference of smoking history based on code for

smoking cessation advice)

Optum HumedicaProprietary database containing health plan

administrative and claims records. The data derive from commercial health plans and Medicare

Advantage programs.

USA Adminsitrative/Billing Data

4 of 12• Only group A can be evaluated and only based on codes for smoking cessation (i.e. no smoking code, but inference of smoking history based on code for

smoking cessation advice)

Information has not been provided for: COBRA (France); COLIBRI (France); INITIATIVES (France); SPIROMICS (USA); CONCERT(USA); COSYCONET (Germany). These databases do not meet the eligibility criteria of “random or representative samples” so will not be eligible for inclusion in the first phase of this population characterization and agreement study

Database information: summary (II)

DATABASE

Evaluation yearNumber of unique patients with ≥1

HCP contact (for asthma, COPD, both of ACOS)

in the evaluation year

Number of unique patients with ≥2 HCP contacts

(for asthma, COPD, both of ACOS) in the evaluation year

Number of unique patients with ≥1 HCP contact

not coded for asthma, ACOS or COPD in the evaluation year

Number of unique patients with ≥2 HCP contact

(for any reason) in evaluation year

Latest 12-month period for which data are available

This criterion is designed to capture the total number of asthma, COPD and ACOS

patients in the database within the proposed 12-month evaluation period

Patients with ACOS based co-coding of asthma and COPD within a 12-month window & presumptive diagnosis of

asthma or COPD in patients 2 consistent asthma or COPD codes in the 12-month

period

Total number of potential control patients in the database within the

proposed 12-month evaluation period

Number of potential control patients within the database – those with ≥2 encounters, neither of which have a

diagnosis of Asthma, COPD or ACOS in the 12-month period

Dutch ASTHMA / COPD Service Jan 2013–31 Dec 2014

Asthma: 1694 COPD: 946ACOS: 324

Unnecessary as code for ACOS exists within the Netherlands Control: 3918 TBC

Adelphi Respiratory Disease Specific Programme

Dec 2014–Nov 2015Asthma: 5,501COPD: 5,071

ACOS: 449 (physician-confirmed)

0; database contains pt data from 1 encounter only Control: not available (n=0) Control: not available (n=0)

Optimum Patient Care Research Database (OPCRD)

March 31 2011 – April 1 2012

Asthma, COPD or Both: 119,540Asthma: subset of aboveCOPD: subset of aboveACOS: subset of above

Asthma, COPD or Both: 40726Asthma: subset of aboveCOPD: subset of aboveACOS: subset of above

Control: 40726 TBC

SIDIAP Jan 07 2013–Dec 31 2013



TBC TBC

MAJORICA

1 January 2014–31 December 2014

(data collection period 2011-2014)

based on ICD everAsthma: 45,800COPD: 27,871ACOS: 5,093

Asthma: <45,800COPD: <27,871ACOS: <5100

Subset of 68,578 Subset of 68,578

PCORnet Common Data Model

1 January 2014 – 31 December 2014

All patients: 100,000,000 million records (total)

Asthma: ~6 million asthma patients (based on prevalence estimate);

COPD: ~6 million asthma patients (based on prevalence estimate);

ACOS: TBC

Asthma: TBCCOPD: TBCACOS: TBC

TBC TBC

HealthCore May 1 2014 – April 30 2015

Asthma, COPD or Both: 603,001(ICD-9 codes 491.xx–496.xx)

Asthma: subset of aboveCOPD: subset of aboveACOS: subset of above

Asthma, COPD or Both: 312,075 (ICD-9 codes 491.xx–496.xx)


TBC TBC

MarketScan Jan 01 2013–Dec 31 2013

Asthma, COPD or Both: 1,998,509Asthma: subset of aboveCOPD: subset of aboveACOS: subset of above

Asthma, COPD or Both: 1,436,631


Control: ? Control: ?

Optum Humedica Jan 01 2013–Dec 31 2013

Asthma, COPD or Both: 1,248,091Asthma: subset of aboveCOPD: subset of aboveACOS: subset of above


Control: ? Control: ?

ACOS Definitions Prospectus Paper

Prospectus Paper…?


Prospectus paper…?

• Rationale: o Optimising the value of the definition creation & database

characterization process carried out to dateo Save other groups doing similar ground worko Set up the planned analysis

• Content:o The process the group has used to create the ACOS definitions o Key characteristics necessary for contributing databaseso Plans for evaluation (and future study opportunities)

• ATS Abstract – OPCRD analysis? (deadline 4 November)

reg acos working group meeting 25/09/15

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