Citation

Sun JW, Franklin JM, Rough K, Desai RJ, Hernández-Díaz S, Huybrechts KF, Bateman BT. PLoS One 2020; 15(10): e0241083.

Copyright

(Copyright © 2020, Public Library of Science)

DOI

10.1371/journal.pone.0241083

PMID

33079968

PMCID

PMC7575098

Abstract

INTRODUCTION: With increasing rates of opioid overdoses in the US, a surveillance tool to identify high-risk patients may help facilitate early intervention.
OBJECTIVE: To develop an algorithm to predict overdose using routinely-collected healthcare databases.
METHODS: Within a US commercial claims database (2011-2015), patients with ≥1 opioid prescription were identified. Patients were randomly allocated into the training (50%), validation (25%), or test set (25%). For each month of follow-up, pooled logistic regression was used to predict the odds of incident overdose in the next month based on patient history from the preceding 3-6 months (time-updated), using elastic net for variable selection. As secondary analyses, we explored whether using simpler models (few predictors, baseline only) or different analytic methods (random forest, traditional regression) influenced performance.
RESULTS: We identified 5,293,880 individuals prescribed opioids; 2,682 patients (0.05%) had an overdose during follow-up (mean: 17.1 months). On average, patients who overdosed were younger and had more diagnoses and prescriptions. The elastic net model achieved good performance (c-statistic 0.887, 95% CI 0.872-0.902; sensitivity 80.2, specificity 80.1, PPV 0.21, NPV 99.9 at optimal cutpoint). It outperformed simpler models based on few predictors (c-statistic 0.825, 95% CI 0.808-0.843) and baseline predictors only (c-statistic 0.806, 95% CI 0.787-0.26). Different analytic techniques did not substantially influence performance. In the final algorithm based on elastic net, the strongest predictors were age 18-25 years (OR: 2.21), prior suicide attempt (OR: 3.68), opioid dependence (OR: 3.14).
CONCLUSIONS: We demonstrate that sophisticated algorithms using healthcare databases can be predictive of overdose, creating opportunities for active monitoring and early intervention.

Language: en

Keywords

Adolescent; Adult; Aged; Analgesics, Opioid; Drug Overdose; Drug Prescriptions; Facilities and Services Utilization; Female; Health Services; Humans; Insurance Claim Review; Male; Middle Aged; Opioid-Related Disorders; Practice Patterns, Physicians'; Risk Assessment; United States; Young Adult