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Comorbidity Index for Female with Breast Cancer

Purpose: To estimate the impact of comorbid conditions on survival in a female with breast cancer using the comorbidity index of Klabunde et al.

Description

Klabunde et al developed a comorbidity index for females with breast cancer based on analysis of Medicare data. This can help identify a patient who may benefit from more aggressive management. The authors are from the National Cancer Institute in Bethesda, Maryland.


Data was available from:

(1) inpatient Medicare claims

(2) physician Medicare claims

 

This data was analyzed to determine coefficients for common comorbid conditions.

 

Comorbid Condition

Inpatient Claim Coefficients

Physician Claim Coefficients

cerebrovascular disease

-0.09

1.10

chronic pulmonary disease

0.83

0.84

congestive heart failure

0.76

0.74

dementia

0.14

1.07

diabetes mellitus, uncomplicated

0.52

0.65

diabetes with complications

0.64

0.36

liver disease, mild

1.19

1.63

myocardial infarction, acute

0.05

-0.99

myocardial infarction, old

1.00

0

paralysis

1.23

-0.08

peptic ulcer disease

0.03

-0.65

peripheral vascular disease

0.23

0.75

renal disease, moderate to severe

1.34

1.20

rheumatologic disease

0.92

-0.45

 

where:

• The coefficient for moderate or severe liver disease is not given. It should be higher than for mild liver disease, but the coefficient for mild disease will be used until a better value is known.

 

For each type of claim (inpatient or physician), identify all of the comorbid conditions present and list the corresponding coefficients.

 

sum of coefficients =

= SUM(coefficients for all comorbid conditions present)

 

chances of patient dying within 2 years when compared to a patient of similar age with similar disease but with no comorbid condition =

= EXP(sum of coefficients)


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Objective

ICD-10