Cohort Definition Name : All events of Respiratory syncytial virus infection, with 30 days washout
Contributor name : Nathan Hall, Rupa Makadia
Contributor OrcId :
Logic Description : All events of Respiratory syncytial virus infection, with no such events in prior 30 days (washout). Persons exit the cohort at the start date + 30 day.
Recommended study application : target
Assertion statement : This cohort definition was executed on at least one real person-level observational health data source and resulted in a cohort with at least 1 person.
Target Clinical Description : Respiratory syncytial virus (RSV) is an enveloped respiratory virus, belonging to the family of the pneumoviridae, with a single-stranded negative-sense RNA genome. Two antigenic and genetic distinct RSV types have been identified, RSV-A and RSV-B, that can co-circulate during the same RSV season. RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. Severe RSV disease is #1 reason infants under 1 year of age are hospitalized in the US.
"Evaluation conclusion : We developed a prevalent cohort definition for Respiratory Syncytial Virus (RSV) using a concept set of 1 concept which incorporated all those found from the literature review, the analysis of PHOEBE, and orphan concepts in cohort diagnostics. We performed the evaluation across a network of claim data sources and 1 EHR US data source. The data sources are: IBM® MarketScan® Commercial Database (CCAE), Optum’s longitudinal EHR repository (Optum EHR), Optum’s Clinformatics® Data Mart (DOD), IBM® MarketScan® Multi-State Medicaid Database (MDCD), IBM® MarketScan® Medicare Supplemental Database (MDCR), Japan Claims Database (JMDC), Clinical Practice Research Datalink (CPRD) , IQVIA® Australia Longitudinal Patient Data (LPD) database (Australia), IQVIA® Disease Analyzer (DA) France database (France), QVIA® Disease Analyzer (DA) Germany database (Germany), IQVIA® Adjudicated Health Plan Claims Data (formerly PharMetrics Plus) - US database (PharMetrics), IQVIA® Ambulatory EMR (EMR). The algorithm retrieves subjects from 9 databases tested. We also developed a more specific cohort requiring either a second diagnosis code for RSV within 7 days, a lab test for RSV within ±7 days, or a hospitalization, given the possibility of the single-code prevalent cohort including some rule-out diagnoses. However, this cohort slightly improves the specificity and PPV of the algorithm albeit at the expense of sensitivity as determined by PheValuator. It should be noted that there is a drastic reduction in sensitivity (> 50% reduction) when using the more specific cohort. additionally, the cohort characteristics are extremely similar between this more general definition and more specific definitions indicating that we are still able to accurately capture the same/similar types of patients without the need for a stricter phenotype algorithm (including RSV tests, hospitalization, etc.) Furthermore, the high PPV and sensitivity using the prevalent cohort are very similar to the findings from the NIH paper (Validating International Classification of Disease 10th Revision algorithms for identifying influenza and respiratory syncytial virus hospitalizations - PMC), which indicate a similar PPV (91%) and sensitivity (69%) and also uses a single RSV code in their phenotype algorithm.
Performance characteristics were determined for 6 of the 9 databases (SES was used instead of DOD, but results should be the same). The remaining databases did not contain enough subjects to produce an accurate diagnostic model. Using Definition A (one code), sensitivity ranged from about 35.7% in EHR to about 87.8% in MDCR while positive predictive value ranged from about 88.9% in MDCR to about 99.8% in JMDC. It is important to note that usingthis deffinition, the low sensitivity of 35.7% in EHR was the only sensitivity that was less than ~70%.