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Table 1 Code algorithm for assigning insured patients to treatment groups and cancer type

From: Use of algorithms for identifying patients in a German claims database: learnings from a lung cancer case

Treatment group

Drug name

ATC

OPS

Cancer type

Immunotherapy

Cetuximab’

L01XC06

6–001.a

NSCLC

Bevacizumab’

L01XC07

6–002.9

NSCLC

Ipilimumab

L01XC11

6–006.h

NSCLC

Nivolumab

L01XC17

6–008.m

NSCLC

Pembrolizumab

L01XC18

6–009.3

NSCLC

Necitumumab’

L01XC22

6–009.g

NSCLC

Durvalumab

L01XC28

 

NSCLC

Avelumab

L01XC31

 

NSCLC

Atezolizumab

L01XC32

 

NSCLC

Other immunotherapies

 

8–547

 

Inhibitors’

Gefitinib

L01XE02

 

NSCLC

Erlotinib

L01XE03

 

NSCLC

Afatinib

L01XE13

 

NSCLC

Crizotinib

L01XE16

6–006.c

NSCLC

Dabrafenib

L01XE23

6–007.5

NSCLC

Trametinib

L01XE25

6–009.7

NSCLC

Ceritinib

L01XE28

6–008.a

NSCLC

Nintedanib

L01XE31

 

NSCLC

Osimertinib

L01XE35

 

NSCLC

Chemotherapy

Cyclophosphamide

L01AA01

 

SCLC

Ifosfamide

L01AA06

 

SCLC

Trofosfamide

L01AA07

 

SCLC

Lomustine

L01AD02

 

SCLC

Temozolomide

L01AX03

6–002.e

 

Temozolomide

L01AX03

6–005.c

 

Pemetrexed

L01BA04

6–001.c

NSCLC

5-Fluoruracil

L01BC02

 

NSCLC

Gemcitabine

L01BC05

6–001.1

NSCLC

Capecitabine

L01BC06

  

Vinorelbine

L01CA04

 

NSCLC

Etoposide

L01CB01

 

SCLC

Nab-paclitaxel

L01CD01

6–005.d

NSCLC

Paclitaxel

L01CD01

6–001.f

NSCLC

Docetaxel

L01CD02

6–002.h

 
 

Doxorubicin

L01DB01

6–001.b

SCLC

Doxorubicin

L01DB01

6–002.8

SCLC

Epirubicin

L01DB03

 

SCLC

Mitomycin

L01DC03

 

NSCLC

Cisplatin

L01XA01

  

Carboplatin

L01XA02

 

SCLC

Oxaliplatin

L01XA03

  

Topotecan

L01XX17

6–002.4

SCLC

Irinotecan

L01XX19

6–001.3

SCLC

Liposomal irinotecan

L01XX19

6–009.e

SCLC

Folic acid

V03AF03

 

NSCLC

Non-complex chemotherapy

 

8–542

 

Moderately complex and intensive chemotherapy cycle

 

8–543

 

Highly complex and intensive chemotherapy cycle

 

8–544

 

Hyperthermic chemotherapy

 

8–546

 

Percutaneous closed organ perfusion with chemotherapeutic agents

 

8–549

 

Treatment group

Definition

EBM

OPS

 

Radiotherapy

Inpatient radiotherapy

 

OPS 8–52

 

High-voltage therapy

EBM 25320

EBM 25321

EBM 25322

EBM 25323

  

Brachytherapy

EBM 25331

EBM 25333

  

Radiotherapy planning

EBM 25340

EBM 25341

EBM 25342

  

Studya

 

EBM 13461 or

EBM 13492

in conjunction with

EBM 13494

  
 

EBM 02100 (at least 10 min) or

EBM 02101 (at least 60 min)

  
 

EBM 01510 (2 h)

EBM 01511 (4 h)

EBM 01512 (6 h)

  

Other treatment

No documentation of previous treatment in the index quarter, in the first month of first-line therapy or second-line therapy, no documentation of previous treatment in the first quarter after the index quarter or the start of second-line therapy

OR

inpatient treatment (OPS 8–541) within one month after the index quarter or in the first month after the start of second-line therapy or treatments within one quarter after the index quarter or in the first quarter after the start of second-line therapy

Not observable in line

See definition of other treatment in the first section

AND

no follow-up documentation of the patient during first-line or second-line therapy

Late therapy

See definition of other treatment in the first section

AND

possible follow-up documentation of the patient during first-line or second-line therapy

AND

Documentation of previous treatments after first-line or second-line therapy

No follow-up diagnosis

See definition of other treatment in the first section

AND

possible follow-up documentation of the patient during first-line or second-line therapy

AND

no repeated documentation of the diagnosis of lung cancer after the index quarter or in another quarter (violation of IC1)

Surgical intervention, no therapy

See definition of other treatment in the first section

AND

possible follow-up documentation of the patient during first-line or second-line therapy

AND

repeated documentation of the diagnosis of lung cancer after the index quarter or in another quarter (satisfaction of IC1)

AND

documentation of an operation within the observation phase of first-line or second-line therapy (Table 2)

Bronchoscopy, no surgical intervention, no therapy

See definition of other treatment in the first section

AND

possible follow-up documentation of the patient during first-line or second-line therapy

AND

repeated documentation of the diagnosis of lung cancer after the index quarter or in another quarter (satisfaction of IC1)

AND

no documentation of an operation within the observation phase of first-line or second-line therapy (Table 2)

AND

documentation of bronchoscopy within the observation phase of first-line or second-line therapy

No bronchoscopy, no surgical intervention, no therapy

See definition of other treatment in the first section

AND

possible follow-up documentation of the patient during first-line or second-line therapy

AND

repeated documentation of the diagnosis of lung cancer after the index quarter or in another quarter (satisfaction of IC1)

AND

no documentation of an operation within the observation phase of first-line or second-line therapy (Table 2)

AND

No documentation of bronchoscopy within the observation phase of first-line or second-line therapy

  1. ATC Anatomical Therapeutic Chemical Classification System, EBM German outpatient Uniform Assessment Standard Tariff, NSCLC Non-small cell lung cancer, OPS German inpatient Operations and Procedure Code, SCLC Small cell lung cancer
  2. aPatients in this group did not receive any higher-priority treatment within the index quarter or the first month after the start of second-line therapy. Only supplementary services were billed here – not the actual underlying service (e.g. administration of a drug). This category was added, because, pursuant to Art. 35c (2) SGB V [25], in (academic) studies the statutory health insurance fund provides the standard services that are also provided in connection with prescription-only medication
  3. Bevacizumab (targeting VEGF receptor), cetuximab (targeting EGF receptor), and necitumumab (targeting EGF receptor) are listed under the immunotherapy section because these are monoclonal antibodies