Advanced cancer often presents as obstruction of the duodenum or large bowel. Stent placements to relieve the obstruction have been successfully performed in the past few years but there is only limited data on outcomes and almost no information on cost. If stenting does provide better outcomes then this should be a treatment modality that is offered to more patients, resulting in significant improvement in quality of life of end-stage cancer patients. The long-term objective is to perform a comprehensive comparison of the outcomes and cost-effectiveness of stents versus alternative treatments using claims data. In 2001, several new CPT-4 codes were established for enteral stent placements and therefore it is possible to track these patients using claims. Prior to initiating this study, an exploratory analysis is proposed with two specific objectives: (i) analyze adoption of stent placements and characterize users of the new technology, and (ii) assess the quality of claims data and the availability of adequate sample size to perform comparative analysis of the outcomes and cost-effectiveness of stents. Analytic files for this study will be constructed from the 5% Medicare Standard Analytic Files (SAFs), the Physician/Supplier Procedure Master File (PSPSF) and the SEER-Medicare linked data. The inpatient, outpatient and physician SAFs will be merged to perform the analysis. Detailed evaluation of the site of service, geographic distribution, physician specialty, and patient characteristics will be performed. Quality of claims data will be tested by deriving the rate of concordance, which is defined as procedures with both Part A and Part B claims, and by documenting missing values for key variables. The initial evaluation will provide valuable information on distribution and use of enteral stents to establish baseline data for future analysis on patterns of adoption and plan for successful execution of cost effectiveness analysis.
