ENRICHING REAL-WORLD TREATMENT-PATTERN ANALYSIS IN OVERACTIVE BLADDER BY LINKING NORSTELLALINQ CLAIMS WITH NORSTELLALINQ ELECTRONIC HEALTH RECORD NOTES USING MANUAL CLINICAL REVIEW
Author(s)
Becky Hollenberg, MPH1, Prawallika Gangidi, MPH1, ilan behm, MPH2, Allison Perry, PhD1.
1Norstella, New York, NY, USA, 2Norstella, Englewood, CO, USA.
1Norstella, New York, NY, USA, 2Norstella, Englewood, CO, USA.
OBJECTIVES: Administrative claims capture dispensed prescriptions but miss why patients start, switch, or stop therapy. We linked US claims with electronic health record (EHR) notes using a manual clinical review approach to enrich real-world treatment-pattern analysis in overactive bladder (OAB).
METHODS: Using NorstellaLinQ linked US claims and EHR data (April 2021-June 2023), we identified adults with an OAB diagnosis (ICD-10-CM N32.81), excluding neuromuscular bladder dysfunction (N31.x). Pharmacy claims for OAB anticholinergics and beta-3 adrenergic agonists defined treatment pathways. From 873,609 eligible patients, a random sample of 50 with clinical notes underwent manual clinical review of predefined clinical concepts from unstructured notes, including symptoms, comorbidities, treatment modifications, and documented reasons for switching or discontinuation. Sample representativeness was assessed against the full cohort.
RESULTS: Among the full cohort, 91% received a single agent, 9% two, and 1% three or more, indicating limited switching; when switching occurred, it was most often between anticholinergics and beta-3 agonists. Anticholinergics accounted for most of the OAB treatment share (declining from 76% to 70%), while beta-3 agonist share grew. Notes captured information absent from claims: clinical presentation, treatment response, and treatment switching reasons. The demographics of the 50-patient note sample were comparable to those of the full cohort (74% female; 76% White; 59% aged ≥70 years). Commonly documented symptoms were urinary incontinence 76%, urgency 60%, frequency 42%. 22% of the 50 patient sample had a documented reason for treatment change; coverage and cost barriers (prior-authorization denial, high copay, non-coverage) were cited most often, followed by insufficient efficacy and tolerability concerns.
CONCLUSIONS: Linking claims with EHR notes surfaced treatment dynamics invisible in claims alone, including sample use, undocumented discontinuation, and reasons for therapy change. Scaling this with a human-in-the-loop LLM approach across larger cohorts could improve characterization of treatment persistence, switching, and reasons for therapy modification in real-world studies.
METHODS: Using NorstellaLinQ linked US claims and EHR data (April 2021-June 2023), we identified adults with an OAB diagnosis (ICD-10-CM N32.81), excluding neuromuscular bladder dysfunction (N31.x). Pharmacy claims for OAB anticholinergics and beta-3 adrenergic agonists defined treatment pathways. From 873,609 eligible patients, a random sample of 50 with clinical notes underwent manual clinical review of predefined clinical concepts from unstructured notes, including symptoms, comorbidities, treatment modifications, and documented reasons for switching or discontinuation. Sample representativeness was assessed against the full cohort.
RESULTS: Among the full cohort, 91% received a single agent, 9% two, and 1% three or more, indicating limited switching; when switching occurred, it was most often between anticholinergics and beta-3 agonists. Anticholinergics accounted for most of the OAB treatment share (declining from 76% to 70%), while beta-3 agonist share grew. Notes captured information absent from claims: clinical presentation, treatment response, and treatment switching reasons. The demographics of the 50-patient note sample were comparable to those of the full cohort (74% female; 76% White; 59% aged ≥70 years). Commonly documented symptoms were urinary incontinence 76%, urgency 60%, frequency 42%. 22% of the 50 patient sample had a documented reason for treatment change; coverage and cost barriers (prior-authorization denial, high copay, non-coverage) were cited most often, followed by insufficient efficacy and tolerability concerns.
CONCLUSIONS: Linking claims with EHR notes surfaced treatment dynamics invisible in claims alone, including sample use, undocumented discontinuation, and reasons for therapy change. Scaling this with a human-in-the-loop LLM approach across larger cohorts could improve characterization of treatment persistence, switching, and reasons for therapy modification in real-world studies.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD186
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Urinary/Kidney Disorders