The sensitivity of medicare claims data for case ascertainment of six common cancers

BACKGROUND. Although Medicare claims data have been used to identify cases of cancer in older Americans, there are few data about their relative sensi tivity. OBJECTIVES. To investigate the sensitivity of diagnostic and procedural cod ing for case ascertainment of breast, colorectal, endometrial, lung, pancre atic, and prostate cancer. SUBJECTS. Three hundred and eighty nine thousand and two hundred and thirty -six patients diagnosed with cancer between 1984 and 1993 resided in one of nine Surveillance Epidemiology and End Results (SEER) areas. MEASURES. The sensitivity of inpatient and Part B diagnostic and cancer-spe cific procedural codes for case finding were compared with SEER. RESULTS. The sensitivity of inpatient and inpatient plus Part B claims for the corresponding cancer diagnosis was 77.4% and 91.2%, respectively. The s ensitivity of inpatient claims alone was highest for colorectal (86.1%) and endometrial (84.1%) cancer and lowest for prostate cancer (63.6%). However , when Part B claims were included, the sensitivity for diagnosis of breast cancer was greater than for other cancers (93.6%). Inpatient claim sensiti vity was highest for earlier years of the study, and, because of more compl ete data and longer follow up, the highest sensitivity of combined inpatien t and Part B claims was achieved in the late 1980s or early 1990s. CONCLUSIONS. Medicare claims provide reasonably high sensitivity for the de tection of cancer in the elderly, especially if inpatient and Part B claims are combined. Because the study did not measure other dimensions of accura cy, such as specificity and predictive value, the potential costs of includ ing false positive cases need to be assessed.