1. Prospection
  2. Cohort/Condition Definitions & Set-up
  3. USA

US Claims Data

Updated
0

Data Overview

Patient Coverage

Over 300 million patients are represented in the dataset

Healthcare Professionals

Information from over 2 million annual HCPs

Payer Representation

Includes 98% of payers

Data Update Frequency

Weekly and Monthly

 

Data Type US Claims Data (Open and Closed) 2015-Present
Compliance HIPAA compliant
Data Anonymity Deidentified, Patient level data
Hospital Coverage Data from over 5,000+ hospitals
Annual Hospital Claims Over 300 million annual hospital claims recorded
Data Quality High-quality longitudinal, thoroughly cleaned and validated data
Data Accessibility Data is easily accessible through Prospection’s SaaS platform
Security Data storage and transfer is secure and meets all legal and regulatory requirements

 
Update Frequency Open claims are updated weekly or monthly, and closed claims are updated on a quarterly basis.
Average Delays Most pharmacy claims typically take about 14 days to reach Prospection’s database, while more complex medical claims may require anywhere from 30 to as many as 90 days to finalise and reach Prospection’s database.

 

Patient Counts

By year, open/closed claims

  Claim Counts Patient Counts Claim Counts  Patient Counts
Past five years Hospital - Open Pharmacy - Open Hospital - Closed Pharmacy - Closed
2018 211,699,453 96,275,032 36,584,465 19,846,826
2019 205,809,917 98,719,250 37,115,062 20,051,043
2020 202,256,160 95,268,449 37,330,718 18,832,348
2021 220,795,095 115,136,069 38,838,649 20,951,270
2022 189,767,908 105,335,148 22,649,480 12,740,650

 

By Payer

 #Patients in Open Claims

  Number of Patients % Patients
Commercial 421,100,639 69%
Medicare 85,611,851 14%
Medicaid 69,047,476 11%
Unknown 28,960,102 5%
Veteran Affairs 3,243,790 1%

 

By Region

  Open Closed
South 32% 47%
Midwest 16% 23%
Northeast 16% 18%
West 20% 10%
Other/Not Specified 16% 1%

 

TA Patient Stats - Free Trial vs. Full

1. Lung Cancer

Therapeutic Area 1 Lung Cancer (Malignant Neoplasm of Bronchus and Lung)
Cohort Definition

Information on all hospital and pharmacy claims for individuals who have been diagnosed with lung cancer at any point in time.


 

Defined by ICD-9-CM and ICD-10-CM codes - 162, 1622, 1623, 1624, 1625, 1628, 1629, C34, C340, C3400, C3401, C3402, C341, C3410, C3411, C3412, C342, C343, C3430, C3431, C3432, C348, C3480, C3481, C3482, C349, C3490, C3491, C3492

 

Data Sample Statistics

  Your Free Trial Licence Full Prospection Platform
Total Patients 130,861 2,621,776
Total Diagnosing HCPs 203,626 334,673

 

2. Prostate Cancer

Therapeutic Area 2 Prostate Cancer (Malignant neoplasm of the prostate)
Cohort Definition

Information on all hospital and pharmacy claims for individuals who have been diagnosed with prostate cancer at any point in time.


 

Defined by ICD-9-CM and ICD-10-CM codes - 185, C61

 

Data Sample Statistics

  Your Free Trial Licence Full Prospection Platform
Total Patients 96,960 4,318,960
Total Diagnosing HCPs 140,908 327,108


3. DLBCL (Diffuse large B-cell lymphoma)

Therapeutic Area 3 DLBCL (Diffuse large B-cell lymphoma)
Cohort Definition

Information on all hospital and pharmacy claims for individuals who have been diagnosed with diffuse large B-cell lymphoma at any point in time.


 

Defined by ICD-9-CM and ICD-10-CM codes - C833, C8330, C8331, C8332, C8333, C8334, C8335, C8336, C8337, C8338, C8339

 

Data Sample Statistics

  Your Free Trial Licence Full Prospection Platform
Total Patients 16,780 335,718
Total Diagnosing HCPs 38,185 84,363

 

4. Schizophrenia

Therapeutic Area 4 Schizophrenia
Cohort Definition

Information on all hospital and pharmacy claims for individuals who have been diagnosed with schizophrenia at any point in time.


 

Defined by ICD-9-CM and ICD-10-CM codes - 

295, 2950, 29500, 29501, 29502, 29503, 29504, 29505, 2951, 29510, 29511, 29512, 29513, 29514, 29515, 2952, 29520, 29521, 29522, 29523, 29524, 29525, 2953, 29530, 29531, 29532, 29533, 29534, 29535, 2954, 29540, 29541, 29542, 29543, 29544, 29545, 2955, 29550, 29551, 29552, 29553, 29554, 29555, 2956, 29560, 29561, 29562, 29563, 29564, 29565, 2958, 29580, 29581, 29582, 29583, 29584, 29585, 2959, 29590, 29591, 29592, 29593, 29594, 29595, F20, F200, F201, F202, F203, F205, F208, F2081, F2089, F209

 

Data Sample Statistics

  Your Free Trial Licence Full Prospection Platform
Total Patients 124,512 2,493,300
Total Diagnosing HCPs 163,514 361,133

 

5. Pulmonary Arterial Hypertension

Therapeutic Area 5 Pulmonary Arterial Hypertension
Cohort Definition

Information on all hospital and pharmacy claims for individuals who have been diagnosed with pulmonary arterial hypertension at any point in time.


 

Defined by ICD-9-CM and ICD-10-CM codes - 4160, I270, I2721, P2930

 

Data Sample Statistics

  Your Free Trial Licence Full Prospection Platform
Total Patients 10,929 1,172,158
Total Diagnosing HCPs 14,519 183,621

 

6. Psoriasis

Therapeutic Area 6 Psoriasis
Cohort Definition

Information on all hospital and pharmacy claims for individuals who have been diagnosed with psoriasis at any point in time.


 

Defined by ICD-9-CM and ICD-10-CM codes - 6960, 6961, L40, L400, L401, L402, L403, L404, L405, L4050, L4051, L4052, L4053, L4054, L4059, L408, L409

 

Data Sample Statistics

  Your Free Trial Licence Full Prospection Platform
Total Patients 245,771 4,898,837
Total Diagnosing HCPs 146,567 441,433

 

Noteworthy Algorithms

  • Stable Panel
    • In many studies, we need to focus on patients who stay enrolled without breaks during the entire study. We've created a system that automatically picks these patients on our platform. We choose these patients based on how long they've been observed and followed up with in the claims data, which could be for 180 days, 360 days, or 720 days.

 

 

  • Physician Attribution Layer
    • We provide the ability to pinpoint the key influencers in patients' treatments, offering insights on potential action points to influence these physicians further.
      • Frequent Provider Identification: The ability to identify the healthcare provider who has most frequently treated a specific patient.
      • Recent Provider Identification: The capability to determine the most recent healthcare provider who treated the patient.
      • Specialty Filter: An option to adjust the specialty type (e.g., oncologist) within a retrospective period prior to the events of interest.

 

 

  • Pharmacy Claims Deduplication:
    • Our algorithms for pharmacy claims incorporate comprehensive deduplication logics on claim adjudication process to distinguish between dispensed, rejected, and abandoned claims. This enhancement minimizes data redundancy and offers more precise insights into treatment patterns.
  • Drug Grouping
    • Prospection utilises enriched reference data to group drugs into the most accurate classifications. We employ the Uniform System of Classification, which generally sorts products based on their therapeutic use. This method serves as an essential tool for standardising and comparing pharmaceutical data across various markets and periods.

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