Development of a Novel Algorithm to Identify People with High Likelihood of Adult Growth Hormone Deficiency in a US Healthcare Claims Database

Abstract

Objective: Adult growth hormone deficiency (AGHD) is an underdiagnosed disease associated with increased morbidity and mortality. Identifying people who may benefit from growth hormone (GH) therapy can be challenging, as many AGHD symptoms resemble those of aging. We developed an algorithm to potentially help providers stratify people by their likelihood of having AGHD.

Design: The algorithm was developed with, and applied to, data in the anonymized Truven Health MarketScan® claims database. Patients. A total of 135 million adults in the US aged ≥18 years with ≥6 months of data in the Truven database. Measurements. Proportion of people with high, moderate, or low likelihood of having AGHD, and differences in demographic and clinical characteristics among these groups.

Results: Overall, 0.5%, 6.0%, and 93.6% of people were categorized into groups with high, moderate, or low likelihood of having AGHD, respectively. The proportions of females were 59.3%, 71.6%, and 50.4%, respectively. People in the high- and moderate-likelihood groups tended to be older than those in the low-likelihood group, with 58.3%, 49.0%, and 37.6% aged >50 years, respectively. Only 2.2% of people in the high-likelihood group received GH therapy as adults. The high-likelihood group had a higher incidence of comorbidities than the low-likelihood group, notably malignant neoplastic disease (standardized difference -0.42), malignant breast tumor (-0.27), hyperlipidemia (-0.26), hypertensive disorder (-0.25), osteoarthritis (-0.23), and heart disease (-0.22).

Conclusions: This algorithm may represent a cost-effective approach to improve AGHD detection rates by identifying appropriate patients for further diagnostic testing and potential GH replacement treatment.

Figure 1

Schematic of a novel algorithm to categorize people by their likelihood of having AGHD using administrative claims data. The algorithm considered diagnosis codes, diagnostic tests, and treatments for each person in the study population. The flowchart consists of a number of guiding rules (diamonds), which result in the placement of each person into one of three groups by their likelihood of having AGHD. Each diamond is dependent on a set of codes (ICD10CM/ICD09CM for diagnoses, CPT for tests, and ATC for treatments), which, combined with logical rules dependent on age, number of prescriptions, or diagnoses, were used to determine whether each person obeys the rule, as indicated by a green (yes) or dashed orange (no) arrow. AGHD, adult growth hormone deficiency; ATC, anatomical therapeutic chemical; CPT, current procedural terminology; GH, growth hormone; GHD, growth hormone deficiency; ICD09CM, International Classification of Diseases, ninth revision, Clinical Modification; ICD10CM, International Classification of Diseases, tenth revision, Clinical Modification.