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Validation of expert opinion in identifying comorbidities associated with atopic dermatitis/eczema

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Abstract

Background: The use of expert opinion is widespread in economic studies of healthcare utilisation; however, few studies have attempted to assess the validity of assumptions derived from such sources.

Objective: To examine the use of such expert opinion in determining comorbidities associated with atopic dermatitis/eczema (AD/E), which were assessed as part of a recent third-party payer cost-of-illness study.

Design: To identify the disease-related comorbidities that would represent costs associated with AD/E, physicians on an expert panel were asked individually and then collectively to group all International Classification of Diseases, 9th Edition—Clinical Modification (ICD-9-CM) diagnosis codes as ‘most likely’, ‘possibly’ or ‘definitely not’ related to the costs of identifying and treating patients with AD/E. Claims representing $US464 million in payer reimbursements from nearly 125 000 patients with AD/E were identified within two separate claims databases (1997 values). Over 850 ICD-9-CM diagnosis codes were identified in the first-listed position from these claims. For each group of ‘most likely’, ‘possibly’ and ‘definitely not’ related diagnosis codes, prevalence rates were compared within AD/E and non-AD/E populations from the two historical payer claims databases. Adjusted and non-adjusted odds ratios were calculated by comparing prevalence rates between AD/E and non-AD/E patients in the same payer population.

Results: The mean prevalence rate of any diagnosis code in the AD/E population was 0.65 ± 1.82% (SD) with a mean odds ratio of 1.81 ± 0.96. Comorbidities considered by the expert panel ‘most likely’ to be associated with AD/E had higher prevalence rates (3.28 ± 3.63%) and odds ratios (2.14 ± 1.14). Comorbidities considered to be ‘possibly’ related to AD/E had prevalence rates and odds ratios of 3.01 ± 5.06% and 1.84 ± 0.82, respectively. Comorbidities considered to be ‘definitely not’ related to AD/E had the lowest prevalence rates (0.45 ± 1.09%) and odds ratios (1.80 ± 0.97).

Conclusions: Comparing the result of consensus panels with actual claims histories validated the use of expert opinion in determining comorbidities associated with AD/E. Expert opinion yielded valid results in terms of identifying comorbidities that manifested frequently and disproportionately in the AD/E population. Limited statistical measurements of comorbidities would have been less specific than expert opinion. Future cost-of-illness studies should consider alternative data sources and methodologies to enhance the validity and importance of expert opinion and to corroborate their findings.

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Acknowledgements

Supported by Fujisawa Healthcare, Inc. All physician authors were compensated for their time serving on the advisory board for this work. Ms Prendergast is an employee of Fujisawa. Dr Ellis and Mr Tong are consultants to Fujisawa. Drs Ellis, Drake, Abramovits, Boguniewicz, Daniel, Lebwohl, and Whitaker-Worth have been investigators for clinical trials sponsored by Fujisawa. Drs Drake, Abramovits, Boguniewicz, Stevens, and Whitaker-Worth have been compensated by Fujisawa for speaking engagements. Dr Stevens has received a research grant from Fujisawa.

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Authors and Affiliations

  1. Department of Dermatology, University of Michigan Medical School and Veterans Administration Medical Center, Ann Arbor, Michigan, USA

    Charles N. Ellis

  2. Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA

    Lynn A. Drake

  3. Fujisawa Healthcare, Inc., Deerfield, Illinois, USA

    Mary M. Prendergast

  4. Baylor University Medical Center and University of Texas Southwestern School of Medicine, Dallas, Texas, USA

    William Abramovits

  5. National Jewish Medical and Research Center, Denver, Colorado, USA

    Mark Boguniewicz

  6. University of Mississippi, Jackson, Mississippi, USA

    C. Ralph Daniel

  7. The Mount Sinai School of Medicine of New York University, New York, New York, USA

    Mark Lebwohl

  8. University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA

    Seth R. Stevens

  9. University of Connecticut Health Center, Farmington, Connecticut, USA

    Diane L. Whitaker-Worth

  10. Quorum Consulting, Inc., 442 Post Street, Ninth Floor, San Francisco, California, 94102-1510, USA

    Kuo B. Tong

Authors
  1. Charles N. Ellis
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  2. Lynn A. Drake
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  3. Mary M. Prendergast
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  4. William Abramovits
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  5. Mark Boguniewicz
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  6. C. Ralph Daniel
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  7. Mark Lebwohl
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  8. Seth R. Stevens
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  9. Diane L. Whitaker-Worth
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  10. Kuo B. Tong
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Corresponding author

Correspondence to Kuo B. Tong.

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Ellis, C.N., Drake, L.A., Prendergast, M.M. et al. Validation of expert opinion in identifying comorbidities associated with atopic dermatitis/eczema. Pharmacoeconomic 21, 875–883 (2003). https://doi.org/10.2165/00019053-200321120-00004

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  • DOI: https://doi.org/10.2165/00019053-200321120-00004

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