dr. michiel callens intermutualistic agency (ima-aim) what can reimbursement data tell us about...

DR. MICHIEL CALLENS INTERMUTUALISTIC AGENCY ( IMA-AIM)

What can reimbursement data tell us about binge drinking in

Belgian minors?

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Objectives

Is it possible to estimate prevalence of binge drinking in Belgian minors from administrative data? “Binge drinking” =

> 5 (adult man) / 4 (adult woman) alcohol units per occasion* No related code (“Nomenclature”) of reimbursed care!

We will use an approximation, starting from code for determination of blood alcohol concentration” (BAC)

* Wechsler H, Dowdall GW, Davenport A, Rimm EB.

A gender-specific measure of binge drinking among college students. Am 3 Public Health 1995; 85: 982-985.

November 8, 2013What can administrative data tell us about binge drinking in Belgian minors?

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Objectives

Is it possible to estimate prevalence of binge drinking in Belgian minors from administrative data? Exploration of approximative number of cases of

alcohol intoxication per year in minors (12-17 years old)

Exploration of related reimbursed health care Comparison of prevalence in minors (age 12-17) with

young adults (age 18-29)

November 8, 2013What can administrative data tell us about binge drinking in Belgian minors?

What can administrative data tell us about binge drinking in Belgian minors?

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Methodology : source data

The InterMutualistic Agency (IMA-AIM) disposes of different databases All insured persons (= 99% of Belgian population) Data on age – gender – socio-economic status (proxy

through preferential reimbursement) … Claims data on reimbursed care and medication Data collection for research purposes

November 8, 2013


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Methodology : source data

The InterMutualistic Agency (IMA-AIM) disposes of different databases April 2014: complete data on reimbursed health care

starting from 2006 < 2013:

data on specific domains (general practitioners, hospital care, medication) collected by default

Other health care: project-specific data collection 2013: transition period

specific data collection “binge drinking” not feasible Workarround: data of three largest sickness funds

88,5% of population

November 8, 2013


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Methodology: detection binge drinking

Estimation of prevalence in minors (12-17) By age, gender, socio-economic status Data of 3 sickness funds 2008-2012

Comparison prevalence minors and young adults (18-29) Data of 3 sickness funds 2008-2012

November 8, 2013


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Methodology: detection binge drinking

Alcohol intoxication = Detection of reimbursed “determination of blood

alcohol concentration” (BAC) Codes “Nomenclature”: 547035, 547046, 547050,

547061

Plus visit emergency unit (590531, 590575, 590656, 590693, 590774, 590811; 590516, 590553, 590634, 590671, 590752, 590796)

OR 1(/2) day(s) hospital stay

November 8, 2013


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Methodology: exploration health care

Minors with (supposed) alcohol intoxication/binge drinking Exploration of health care on day = day BAC

Number of patients with reimbursed health care in specific health care categories (contacts, imaging, clinical biology,…)

Mean reimbursed health care per patient Data of 1 sickness fund 2008-2012

November 8, 2013


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Results: supposed binge drinking in minors

November 8, 2013

No. cases of 2008 2009 2010 2011 2012Determination blood alcohol concentration (BAC) [1]

2.624 2.803 2.774 2.745 2.749

BAC + emergency unit

BAC + 1 day hospital

BAC + 2 days hospital

Binge-drinking(?) [2]

(denominator = no. insured individuals age 12-17) [3]BAC: [1] * 10.000 insured individuals / [3]binge drinking (?): [2] * 10.000 insured individuals / [3]


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November 8, 2013


2.624 2.803 2.774 2.745 2.749

BAC + emergency unit 1.071 1.083 1.196 1.196 1.273

BAC + 1 day hospital 702 803 686 706 676

BAC + 2 days hospital 158 171 146 146 152

Binge-drinking(?) [2] 1.931 2.057 2.028 2.048 2.101

(denominator = no. insured individuals age 12-17) [3]

669.518 666.545

662.359

658.542

659.919

BAC: [1] * 10.000 insured individuals / [3]binge drinking (?): [2] * 10.000 insured individuals / [3]


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November 8, 2013


2.624 2.803 2.774 2.745 2.749

BAC + emergency unit 1.071 1.083 1.196 1.196 1.273

BAC + 1 day hospital 702 803 686 706 676

BAC + 2 days hospital 158 171 146 146 152

Binge-drinking(?) [2] 1.931 2.057 2.028 2.048 2.101

(denominator = no. insured individuals age 12-17) [3]

669.518 666.545

662.359

658.542

659.919

BAC: [1] * 10.000 insured individuals / [3]

39 42 42 42 42

binge drinking (?): [2] * 10.000 insured individuals / [3]

29 31 31 31 32


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Results: comparison Dutch registration data

Results registration data in the Netherlands (Van Zanten et al. 2013*)

*van Zanten E, De Dooy J, Ramet J, van der Lelie N. 2013. Nederlandse ervaringen met alcoholintoxicaties bij minderjarigen: aankondiging van de Belgische registratie door kinderartsen. Tijdschr. voor Geneeskunde 69 (9).

November 8, 2013


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Results: comparison young adults

November 8, 2013

Period 2012 Age 12-17: 2.101 cases

in a group of 10.000 minors: 31,8 Age 18-29: 9.835 cases

in a group of 10.000 young adults: 67,6 ( 2,1x)

Methodology aspecific in case of young adults (car accidents … !)


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Results: binge drinking by age

November 8, 2013


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Results: comparison Dutch registration data

Results registration data in the Netherlands (Van Zanten et al. 2013*)

*van Zanten E, De Dooy J, Ramet J, van der Lelie N. 2013. Nederlandse ervaringen met alcoholintoxicaties bij minderjarigen: aankondiging van de Belgische registratie door kinderartsen. Tijdschr. voor Geneeskunde 69 (9).

November 8, 2013

Belgium 2011

58%42%

1%4%10%19%30%36%


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Results: binge drinking in minors by gender

November 8, 2013

More frequent for boys than for girls


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Results: binge drinking in minors by socio-economic status

November 8, 2013

Most frequent in minors with preferential reimbursement (proxy lower socio-economic status)


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Discussion: fine-tuning methodology?

November 8, 2013

Large numbers compared to Dutch registration (BE: 2.048 – NL: 762 in 2011) A-specific? False positives? Exclusion of (auto)intoxication / suicide attempts and

accidents? Explore number of patients with

Trauma (identified by acts of medical imaging / ECG / suture)

Intoxication (identified by acts of identification xenobiotica, e.g. medication, drugs, pesticides…)

Trauma + intoxication


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Results: exploration of other health care

November 8, 2013

Number of supposed BD events in minors 2008-2012 : 3.809 (1 sickness fund)

Exploration of health care = frequency of groups of nomenclature codes


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November 8, 2013

Groups of nomenclature with > 9 patients No. Patients (%)

Clinical biology 3.808 (26,9%)

Medication 2.966 (20,9%)

Imaging 1.619 (11,4%)

Surgery 1.330 (9,4%)

Reanimation 1.259 (8,9%)

Technical acts (lump sums) 1.017 (7,2%)

Internal medicine 708 (5,0%)

Contacts 631 (4,5%)

Special acts and punctures (Art 11) 542 (3,8%)

Technical medical acts 133 (0,9%)

Dentistry 73 (0,5%)

Anaesthesiology 50 (0,4%)

Plaster cast 25 (0,2%)


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November 8, 2013

Proportion of cases of minor patients with supposed BD 2008-2012 outside ‘regular hours’ (night, weekend, ferials): 65%

Contacts with psychiatricians: 8% of minor patients with supposed BD 2008-2012

Remarkable prestations (?): dosage of paracetamol for 12% of minor patients with supposed BD 2008-2012


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November 8, 2013

Number of supposed BD events in minors 2008-2012 : 3.809 (1 sickness fund)

After exclusion of cases with ‘trauma’: 3.001 (-21%) ‘intoxication’: 2.440 (-36%) ‘trauma’ or ‘intoxication’: 1.814 (-52%)


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November 8, 2013

Large numbers compared to Dutch registration

2011: BE: 2.048 – NL: 762 After exclusion of 52% of cases with

‘‘trauma’ or ‘intoxication’ 2011: BE: 983 – NL: 762


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Results: costs payed by public health insurance

November 8, 2013

Number of minors with supposed BD event in 2011-2012 : 1.496 (1 sickness fund)

Mean [CI] health care reimbursement per patient: 690 [646, 734] euro on day 1 + 2 following days 547 [518, 577] euro if only day of BAC is taken into

accountMedian health care reimbursement per

patient: 250 euro on day 1 + 2 following days 235 euro if only day of BAC is taken into account


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Conclusion

November 8, 2013

Numbers should be validated against registration data of binge drinking in Belgium fine tuning of methodology

Monitor prevalence of binge drinking in Belgian minors through administrative data? Low cost (APR2014: complete data available at IMA 2006-2012) High reliability if specific (new) code for binge drinking


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Questions - Acknowledgements

November 8, 2013

Researchers Birgit Gielen (CM-MC) Jérôme Vrancken (UNMS-NVSM) Carine Pochet – Agnès Leclercq (ML-OZ)

Experts Dr Bernard Debbaut (CM-MC)

http://www.ima-aim.be

dr. michiel callens intermutualistic agency (ima-aim) what can reimbursement data tell us about...

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