Agreement of Administrative Pharmacy Dispensing With Self-Reported Use of Oral Prednisone in US Veterans With Rheumatoid Arthritis

Objective

Administrative claims are used to evaluate oral glucocorticoid use in rheumatoid arthritis (RA), despite limited evidence to support accuracy. We aimed to evaluate the performance of claims-based algorithms for glucocorticoid use compared to self-report in an RA population.

Methods

Participants with RA enrolled at seven Veterans Affairs Rheumatoid Arthritis (VARA) Registry sites were asked six questions as part of clinical care assessing current prednisone use and dose, recent use, “stockpiling,” and receiving prednisone outside the Department of Veterans Affairs (VA). Algorithms using VA prescription claims operationalized current use (active prescription on date of self-report assessment), current dose (that prescription's mean dose), and recent use (active course overlapping the prior 30 or 90 days). We assessed performance characteristics and agreement, benchmarked on self-report.

Results

Of 284 participants, 13% reported current prednisone use and 20% reported 90-day use. Sensitivity, specificity, positive predictive value, and negative predictive value were 0.70, 0.98, 0.84, and 0.96, respectively, for current use and 0.71, 0.92, 0.72, and 0.92, respectively, for 90-day use. Cohen's κ was 0.68 for current use and 0.63 for 90-day use. Among participants reporting ≤5 mg/day, agreement for dose was high (weighted κ 0.67). One in four participants reported a stockpile, and one in four reported receiving prednisone from a non-VA provider.

Conclusion

Algorithms derived from VA claims detecting prednisone prescriptions have high validity compared to patient self-report. The modest sensitivity of these algorithms may reflect stockpiling and non-VA prescriptions. These findings form a basis for contextualizing real-world studies of glucocorticoid use in RA and improve clinical estimation of glucocorticoid use not captured in claims.