Professional Documents
Culture Documents
DOI 10.1007/s11136-016-1435-y
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AEs of SCS are prevalent and impactful. Based on providers used by MEPS respondents. The MPC supple-
national inpatient data from the Healthcare Cost and ments and validates information on pharmacy events.
Utilization Project, SCS comprised 9.6 % of all adverse Medical conditions reported by individuals or the MPC are
drug events present upon admission to the hospital and mapped to 693 three-digit International Classification of
15.3 % of all that developed in the hospital [3]. In addition Diseases, Ninth Revision (ICD-9) codes by professional
to their deleterious clinical impact, SCS have been shown coders. Further details on MEPS are available at www.
to significantly increase healthcare costs. Sarnes et al. [4] meps.ahrq.gov.
conducted a literature review of the cost of SCS-related Adults C18 years of age who responded to the MEPS
AEs and found the cost to be up to $26,471 (annual; $2009) Self-administered Questionnaire from years 2000–2003
for nonfatal MI and up to $18,356 (per event) for fracture. were included in this analysis. (A sample including
In the most comprehensive direct assessment of the costs of 2000–2012 was included in the sensitivity analysis). MEPS
SCS-related AEs to date, Shah et al. quantified the eco- medical conditions files and prescription drug use files
nomic impact of SCS-related AEs in systemic lupus [5]. were also merged into the analytic sample. The sample
They found that it costs an additional $784 per year per design of the MEPS-HC survey includes stratification,
SCS user to manage known SCS-related AEs compared to clustering, multiple stages of selection and disproportionate
non-SCS users. sampling. MEPS sampling weights incorporate adjustment
While there is some evidence of the cost of AEs asso- for the complex sample design and reflect survey nonre-
ciated with SCS use, there are limited studies to date iso- sponse and population totals from the Current Population
lating the health-related quality of life (HRQoL) impact of Survey. All analyses incorporated the MEPS sampling and
taking SCS apart from the condition for which they are variance adjustment weights. The inclusion of these sample
used. Given the prevalent use of SCS, the potential dele- weights and adjustments ensures that the results are
terious impact of SCS use on HRQoL is important to nationally representative.
characterize. The objective of this study was to assess the
HRQoL of patients taking SCS. Systemic corticosteroids
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We have implemented four specific methods to mitigate Ethnicity was categorized as Hispanic or non-Hispanic.
the potential selection bias in this observational research: Gender (male, female) was included. Poverty category was
(1) limit the study sample to those individuals who have at categorized by the percentage of the federal poverty level:
least one condition for which SCS are commonly pre- poor (\100 %), near poor (100–125 %), low income
scribed; (2) control for the specific conditions for which (125–200 %), middle income (200–400 %), or high
SCS are prescribed (e.g., RA); (3) control for the baseline income (C400 %) (the federal poverty threshold for a
number of outpatient and emergency room visits (repre- family of four in the contiguous USA was $24,250 in
senting severity, acuity and burden of disease); (4) control 2015). The total number of reported chronic conditions (by
for chronic comorbidity (unrelated to SCS use); (5) control ICD-9 code) were added together to create seven distinct
for sociodemographic characteristics. dichotomous variables representing the total number of
In order to control for confounding by indication, we chronic conditions (NCC): NCC = 1, NCC = 2,…,
identified all conditions for which SCS are prescribed. NCC C 7. This was used to control for chronic comor-
Each prescription drug event in MEPS is ascribed a diag- bidity unrelated to SCS use. Only conditions not on the 233
nosis (ICD-9 code) for which the drug was prescribed. We SCS-related ICD-9 codes were included in this variable.
exported all ICD-9 codes associated with SCS use. A board
certified clinical pharmacist then reviewed these ICD-9 HRQoL instruments
codes to identify conditions for which SCS use is clinically
indicated. This resulted in a list of 233 conditions for which The EQ-5D-3L is a five-item descriptive system measuring
SCS were prescribed in MEPS. The full list of 233 con- 5 dimensions of health status (mobility, self-care, usual
ditions is presented in Table 11 of the Appendix. The study activities, pain/discomfort and anxiety/depression) with 3
sample was restricted to those individuals reporting at least levels per dimension (no problem, some problems and
one of these 233 conditions. Regression analyses also extreme problems) [8]. Preferences for the different health
controlled for these conditions in the following manner: states described by the EQ-5D are elicited from a general
The most prevalent 30 conditions were included individu- population sample from which a scoring algorithm is cre-
ally as dichotomous variables (most prevalent was deter- ated to define a preference-based score (‘‘utility’’) for each
mined by the highest number of individuals reporting SCS possible health state [9]. EQ-5D tariffs or scoring systems
use for the condition). The 30 most prevalent conditions are available for numerous countries. This research inclu-
are listed in Table 6 in the Appendix. The remaining 203 ded the EQ-5D tariffs for the USA [9] and the UK [10].
conditions were included in the regressions by creating 9 EQ-5D index scores are anchored on death (value = 0) and
dichotomous indicator variables (SCS Conditions = 1, full health (value = 1.0). Scores below zero are possible.
SCS Conditions = 2,…, SCS Conditions C 9) represent- The EQ-5D questionnaire also includes a single-item
ing the total number of SCS-related conditions reported by question asking about self-perceived health status using a
each individual (excluding the top 30 which were included visual analogue scale (VAS). This question asked respon-
individually). For example, if an individual reported having dents to rate their current overall health on a scale that
RA (a ‘‘top 30’’ condition) and 2 conditions from the list of ranges from 0 to 100, where 0 represents ‘‘worst possible
the remaining 203 conditions, the variable ‘‘SCS Condi- health’’ and 100 represents ‘‘best possible health.’’ The EQ-
tions = 2’’ would equal 1 and the dichotomous indicator 5D has been extensively validated as a generic preference-
variable ‘‘RA’’ would equal 1 in the regressions. The based HRQoL instrument in a variety of conditions and
sample size of each of these categories is also presented in populations in over 6000 publications [11].
the Appendix in Table 7. The SF-6D provides a preference-based single index
measure that can be used to calculate quality-adjusted life
Independent variables years (QALYs). The SF-6D is derived from the SF-12,
which has become one of the most widely used measures of
The main independent variables of interest were related to general health. The SF-6D is a classification system com-
SCS use. SCS use was categorized into three levels: no use; posed of six multi-level dimensions derived from responses
1–3 prescriptions; and C4 prescriptions. Sociodemographic to the SF-12 or SF-36. Preference weights can be applied to
characteristics were included in the regressions as control the responses on the SF-6D to calculate up to 18,000
variables. Education was categorized: no completed high unique health state utility values [12].
school degree; high school degree but no completed
Bachelor’s degree; Bachelor’s degree; and Master’s or Minimum clinically important difference (MCID)
Ph.D. Race was categorized as Caucasian, black, American
Indian or Other. Age was grouped in the following cate- The minimum clinically important difference (MCID) is
gories: 18–29; 30–39; 40–49; 50–59; 60–69; 70–79; C80. often used with statistical significance and effect size to
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provide perspective on the clinical significance of changes questionnaire was discontinued in the MEPS SAQ after
in HRQL results [13]. MCID values are most relevant 2003. Hence, MEPS data including direct elicitation of the
when they are defined for a specific disease state and more EQ-5D are only available until 2003. However, the SF-12
particularly, a specific intervention [14]. Walters et al. [15] instrument is available in more recent data. The largest data
estimated the MCID of the SF-6D to range from 0.011 to set possible was used for each instrument.
0.097, with mean 0.041. In other research, the MCID was
estimated to be 0.03, 0.033 or 0.05 depending on the Sensitivity analyses
method chosen [16]. Walters et al. estimated the EQ-5D
MCID to range from -0.011 to -0.14, with mean 0.074. Sensitivity analysis was conducted on predicted EQ-5D
Others have used an effect size of 0.2 and estimated an scores in order to examine whether or not more recent data
MCID of 0.033 for the EQ-5D [17]. None of these MCID or a larger data set would change the results of the analysis
was estimated in an asthma population. All preference- for the EQ-5D. Hence, predicted EQ-5D (from SF-12)
based HRQL instruments are designed to measure the same scores resulting in a much larger sample size were exam-
latent construct of utility with anchors of death and full ined for MEPS 2000–2012 data. In previous research, Gray
health. The MCID for the Health Utilities Index has been et al. [24] used multinomial logit to map SF-12 responses
estimated to be 0.03 [18]. to EQ-5D questionnaire responses in the 2000 MEPS data.
For this research, the Gray algorithm was applied to a
Statistical analysis larger data sample (MEPS 2000-2003) to estimate the EQ-
5D response prediction equation. More details of the per-
Previous research has shown that preference-based HRQL formance of the Gray et al. [24] algorithm are provided
scores exhibit ceiling effects with a significant number of elsewhere. Briefly, the authors obtain an in-sample (MEPS)
respondents reporting the highest score (1.0). The ceiling mean squared error (MSE) of 0.03 and a mean absolute
effect is particularly evident with the EQ-5D index. As error of 0.11 in predicting actual EQ-5D scores. They also
discussed in previous publications [7, 19, 20], in these tested the algorithm in an exogenous data set (Health
circumstances the Tobit and Censored Least Absolute Survey for England) with MSE/MAE of 0.04/0.12. Gray
Deviations (CLAD) estimator developed by Powell et al. et al. concluded that their algorithm successfully predicts
[21]. has theoretical advantages over the Ordinary Least group mean utility scores and differentiates between
Squares (OLS) estimator [21–23]. In cases where censoring groups with or without known existing illness. The Gray
occurs in less than 50 % of the sample, ‘‘robust regression’’ algorithm was applied to the MEPS 2000–2012 data to
(robust to censoring, outliers and heteroskedasticity—me- predict EQ-5D responses from actual SF-12 responses. The
dian regression) is equivalent to CLAD. In this sample, country-specific EQ-5D tariffs for the USA (Shaw) and UK
censoring occurred in \50 % of the sample and robust (Dolan) were then calculated based on the predicted EQ-
(median) regression was used. Hence OLS, Tobit and 5D question responses, resulting in predicted EQ-5D tariffs
median regression were used in all analyses to estimate for 2000–2012 MEPS data.
EQ-5D index scores and to determine whether the In addition, a sensitivity analysis was conducted within
assumptions of homoskedasticity and normality were valid. one condition. All analyses were restricted to individuals
Because the VAS scores do not exhibit a high degree of reporting ICD-9 716 ‘‘Arthropathies’’ to examine whether
censoring, OLS regression was used. this restriction resulted in any change in the general
HRQoL scores were regressed on ‘‘1–3 SCS prescrip- direction of the results.
tions’’ and ‘‘C4 SCS prescriptions’’ (no SCS use as refer-
ence) controlling for age, gender, race, ethnicity,
education, income category, geographic region, number of Results
ER visits, number of outpatient visits, total number of
chronic conditions (for which SCS are not used), the top 30 The final sample after applying the SCS inclusion criteria
most prevalent conditions for which SCS are used listed and dropping individuals with missing EQ-5D or covariate
individually, and 10 categories representing the total values is presented in Fig. 1. Table 1 shows sociodemo-
number of reported conditions for which SCS are used graphic characteristics of the MEPS 2000–2003 final (EQ-
(with no reported conditions being the reference). 5D) regression sample. Individuals who used C4 SCS
Dependent variables for the main analyses included the prescriptions were older, poorer, had lower education
EQ-5D (UK) EQ-5D (US), EQ-5D VAS and the SF-6D. levels, were more likely to have public insurance, had a
All of the main analyses for the EQ-5D were conducted in greater number of chronic comorbidities and were less
the MEPS 2000–2003 data, while the main analyses for the likely to have private insurance. Appendix Table 12 shows
SF-6D were conducted in the 2000–2012 data. The EQ-5D the descriptive statistics for the MEPS 2000–2012 final SF-
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Table 1 Baseline sociodemographic characteristics (MEPS 2000–2003)
No SCS No SCS (%) SCS (Any) (%) SCS (Any) (%) SCS (1-3 Rx) SCS (1–3 Rx) (%) SCS (C4 Rx) SCS (C4 Rx) (%)
N N N N
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MEPS (Total N) 54,567 2861 2240 621
Age (mean) 47.0 51.7 50.0 58.7
Age 18-34 14,860 28.0 474 18.5 424 20.9 50 8.4
Age 35-49 16,614 30.3 835 29.1 706 31.2 129 20.5
Age 50-64 12,715 23.2 757 25.7 554 24.5 203 30.7
Age 65-79 7782 13.8 619 21.1 443 19.0 176 29.8
Age [ 80 2596 4.7 176 5.6 113 4.5 63 10.5
Region
Northeast 8581 19.2 427 19.3 338 19.3 89 19.2
Midwest 12,178 23.7 687 23.9 558 24.9 129 19.8
South 20,589 34.8 1157 37.9 899 37.6 258 39.3
West 13,219 22.2 590 18.8 445 18.2 145 21.7
Gender
Male 23,267 45.2 990 36.3 778 36.5 212 35.4
Female 31,300 54.8 1871 63.7 1462 63.5 409 64.6
Race
White 44,974 85.2 2412 86.8 1914 87.6 498 83.7
Black 6958 10.0 322 8.3 227 7.4 95 11.7
American Indian 531 0.8 28 1.0 17 0.9 11 1.4
Other-race 2104 4.0 99 3.9 82 4.1 17 3.2
Ethnicity
Hispanic 9683 9.6 341 6.2 254 5.9 87 7.4
Education
No-degree 12,190 16.5 601 16.2 420 14.3 181 24.2
Less-than-BA 30,934 58.1 1707 60.4 1353 60.7 354 58.8
BA 7660 17.0 360 14.9 309 16.3 51 9.5
MA-PhD 3783 8.4 193 8.4 158 8.7 35 7.4
Insurance coverage
Private 37,972 75.9 2007 76.7 1661 80.3 346 61.5
Public 9811 14.0 692 18.8 447 15.1 245 34.3
Uninsured 6784 10.1 162 4.5 132 4.6 30 4.2
Family income
Poor 7439 9.6 410 10.1 294 9.0 116 15.0
Near poor 2712 3.9 142 4.2 100 3.6 42 6.4
Low income 8081 12.4 391 12.3 278 11.0 113 17.7
Mid-income 16,778 31.0 867 31.3 683 31.6 184 29.7
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* Subpopulation of MEPS age C 18, with positive SAQ weight, valid EQ-5D score, presence of any SCS-related condition and complete values for covariates used in regressions (final
treatments examined in this research should incorporate
SCS (C4 Rx) (%) the effects of treatment on HRQoL.
The estimates provided herein may be particularly
useful in estimating the value of SCS use compared to
8.2
3.7
2.4
0.5
385.2
185.0
31.3
21.4
26.9
22.1
14.8
alternative treatments. Payers in the USA and around the
world are struggling to estimate the value of drug treat-
ments for different conditions. Many payers use cost-utility
SCS (C4 Rx)
128
174
143
85
51
24
13
3
estimates of the disutility of taking SCS in cost-utility
N
43.2
28.0
14.2
7.7
4.3
1.8
0.5
0.3
253.4
111.4
who have used SCS for many years as well as those just
initiating SCS treatment. However, it is important to note
that these estimates likely do not fully capture the longer-
SCS (1-3 Rx)
929
623
328
188
102
47
15
8
38.9
27.8
15.8
9.1
5.0
2.2
0.9
0.4
279.1
125.7
1057
797
471
273
153
71
28
11
88.7
52.8
23.8
12.6
28,147
138
13,142
regression sample)
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Baseline RA [7] 0.7780 0.7780 0.7780 0.7780 0.7780 0.7780 0.7780 0.7780 0.7780 0.7780
Age [7] -0.0007 -0.0007 -0.0007 -0.0007 -0.0007 -0.0007 -0.0007 -0.0007 -0.0007 -0.0007
RA [7] -0.0844 -0.0844 -0.0844 -0.0844 -0.0844 -0.0844 -0.0844 -0.0844 -0.0844 -0.0844
SCS -0.0470 -0.0470 -0.0470 -0.0470 -0.0470 -0.0470 -0.0470 -0.0470 -0.0470 -0.0470
Osteoporosis [7] NA NA NA NA -0.0182 -0.0182 -0.0182 -0.0182 -0.0182 -0.0182
NCC = 2 [7] NA NA NA NA -0.0942 -0.0942 -0.0942 -0.0942 -0.0942 -0.0942
QALYs 0.6459 0.6459 0.6459 0.6459 0.5335 0.5335 0.5335 0.5335 0.5335 0.5335
Discounted QALYs 0.6459 0.6271 0.6088 0.5911 0.4740 0.4602 0.4468 0.4338 0.4211 0.4089
RA rheumatoid arthritis, NCC number of chronic conditions, SCS systemic corticosteroids
* Discount rate is 3 % annually
similarity of the results suggests that the use of older MEPS contain any items or domains related to the AEs of SCS. In
data was not a significant concern. In addition, the sensi- cancer, for example, there are instruments that explicitly
tivity analysis restricting the sample to ICD-9 716 showed include questions about the AEs associated with treatment
very similar coefficients compared to the larger sample and [28]. A more specific HRQoL instrument may provide a
provides support for the robustness of the study design. more robust estimate of the impact of SCS-related AEs on
Although the current research found a significant nega- HRQoL. Future studies into the specific domains of pref-
tive association between SCS use and generic, preference- erence-based HRQoL instruments affected by SCS use
based HRQoL scores, it is not clear precisely how SCS use would be beneficial. With better understanding of how SCS
affects specific domains of HRQoL. Previous qualitative use impacts HRQoL, it is possible that clinicians can target
research has shown that SCS use may impact the following treatments that may mitigate their negative effects, par-
domains: depression, irritability, sleep, hunger, weight, ticularly where use of SCS is clinically necessary. Clini-
skin, gastric, pain, disease anxiety and medication anxiety cians currently treat AEs associated with SCS use. For
[25]. Other studies have suggested that SCS use may affect example, asthma guidelines recommend that patients who
mood, causing depression, suicidal ideation, and anxiety, are on long-term SCS should receive preventive drug
and cause physical problems that can have psychological treatment for osteoporosis [1].
effects such as fractures or weight gain [25–27]. One of the There are limitations associated with this research. As
limitations of using the EQ-5D-3L and the SF-6D in this discussed previously, any comparison of individuals taking
research is that they are generic instruments. They do not SCS to those not taking SCS in observational research runs
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the risk of confounding by indication and selection bias. the instruments or other covariate values that may impact
This potential selection bias is very clear when examining the interpretation of the results. The current study provides
the stark differences in unadjusted means for those who use preliminary results that the number of annual prescriptions
C4 SCS prescriptions compared to those who do not use is associated with HRQoL, but future research exploring
SCS (Tables 1, 2). The statistical approach attempted to other measures may be beneficial. An advantage of using a
mitigate this potential bias by controlling for SCS-related simple measure like the number of annual prescriptions is
conditions, chronic comorbidities, baseline outpatient and that it is easily replicated in clinical practice and research
emergency visits and sociodemographics. However, bias without the need for more complicated calculations or data
may still exist. The regression results highlight the neces- availability such as days supplied or the date of fill.
sity of controlling for these characteristics: The coefficients
associated with each of these confounders were substantial
and statistically significant. For example, the EQ-5D (US) Conclusions
decrement associated with the following was quite sub-
stantial: ICD-9 714 RA (SCS-related condition:-0.083); While SCS are an efficacious and widely used treatment for
public insurance (-0.042); high income versus poor numerous conditions, the results presented herein suggest
(0.045); two non-SCS chronic conditions (-0.077). that their use may be associated with a substantial delete-
Nonetheless, it remains a possibility that there are unob- rious impact on HRQoL. This negative effect needs to be
served differences between the SCS groups that may bias considered in balance with the cost and effectiveness of
the results. It is also possible that controlling for chronic SCS and treatment alternatives. Future studies are needed
conditions that are considered long-term AEs of SCS use to corroborate these findings.
(such as osteoporosis and diabetes mellitus) reduced the
negative impact of SCS use. Results should be interpreted Funding This study was funded by a research grant from Amgen,
Inc.
with caution considering the limitations of observational
research. A future randomized, controlled trial would Compliance with ethical standards
provide the most internally valid results. In addition, it is
possible that more granular measures of SCS exposure Conflict of interest Dr. Sullivan has received research grants from
Amgen, Inc. Dr. Globe is an employee and stockholder of Amgen,
could provide additional insight. For example, the number
Inc. Dr. Ghushchyan declares that he has no conflict of interest. Dr.
of days of exposure, the average daily dose or the cumu- Sucher declares that he has no conflict of interest.
lative annual dose may be informative. It is possible that
the final analytic sample is different from the initial MEPS Ethical approval This article does not contain any studies with
sample prior to dropping individuals with missing values. human participants or animals performed by any of the authors.
MEPS uses a valid and reliable national survey design that
has been in use since the 1970s. The response rate in this
research is good for both the EQ-5D and SF-6D final Appendix
regression samples. Nonetheless, it is possible that there
are differences in those individuals who failed to complete See Appendix Tables 6, 7, 8, 9, 10, 11 and 12.
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Table 6 Number of individuals reporting the most prevalent 30 conditions with indications for SCS in MEPS 2000–2003
Condition ICD-9 No SCS SCS (Any) SCS (1–3 Rx) SCS (C4 Rx)
(N)
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Table 7 continued
eq5d_UK Coef. SE t P[t [95 % Conf. Interval]
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Table 7 continued
eq5d_UK Coef. SE t P[t [95 % Conf. Interval]
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Table 8 continued
eq5d_US Coef. SE t P[t [95 % Conf. Interval]
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Table 9 continued
sf6d Coef. SE t P[t [95 % Conf. Interval]
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Table 10 continued
VAS Coef. SE t P[t [95 % Conf. Interval]
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Table 10 continued
VAS Coef. SE t P[t [95 % Conf. Interval]
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ICD-9 389 hearing loss* ICD-9 919 superficial inj oth site*
ICD-9 840 sprain shoulder and arm* ICD-9 698 pruritus and like cond*
ICD-9 V07 prophylactic measures* ICD-9 528 oral soft tissue disease*
ICD-9 525 other dental disorder* ICD-9 848 sprain nec*
ICD-9 790 abnormal blood findings* ICD-9 737 curvature of spine*
ICD-9 459 oth circulatory disease* ICD-9 255 adrenal gland disorders*
ICD-9 845 sprain of ankle and foot* ICD-9 279 dis immune mechanism*
ICD-9 388 disorders of ear nec* ICD-9 314 hyperkinetic syndrome*
ICD-9 174 malig neo female breast* ICD-9 386 vertiginous syndromes*
ICD-9 989 tox eff oth nonmed subst* ICD-9 511 pleurisy*
ICD-9 136 inf/parasite dis nec/nos* ICD-9 693 dermat d/t intern agent*
ICD-9 707 chronic ulcer of skin* ICD-9 380 disorder of external ear*
ICD-9 789 oth abdomen/pelvis symp* ICD-9 202 oth mal neo lymph/histio*
ICD-9 708 urticaria* ICD-9 349 cns disorder nec/nos*
ICD-9 596 other bladder disorders* ICD-9 463 acute tonsillitis
ICD-9 455 hemorrhoids* ICD-9 215 oth ben neo soft tissue*
ICD-9 110 dermatophytosis* ICD-9 464 ac laryngitis/tracheitis*
ICD-9 424 oth endocardial disease* ICD-9 704 hair and follicle disease*
ICD-9 611 other breast disorders* ICD-9 075 infectious mononucleosis
ICD-9 924 contusion leg and oth site* ICD-9 556 idiopathic proctocolitis*
ICD-9 375 lacrimal system disorder* ICD-9 996 replace and graft complic*
ICD-9 041 bact inf in oth dis/nos* ICD-9 289 other blood disease*
ICD-9 569 oth intestinal disorders* ICD-9 V47 oth probl w internal org*
ICD-9 721 spondylosis et al.* ICD-9 117 other mycoses*
ICD-9 696 psoriasis/like disorders* ICD-9 208 leukemia-unspecif cell*
ICD-9 523 gingival/periodontal dis* ICD-9 287 purpura and oth hemor cond*
ICD-9 351 facial nerve disorders* ICD-9 839 dislocation nec*
ICD-9 558 oth noninf gastroenterit* ICD-9 446 polyarterit nodosa et al.*
ICD-9 695 erythematous conditions* ICD-9 V42 organ transplant status*
ICD-9 602 oth prostatic disorders* ICD-9 338
ICD-9 162 mal neo trachea/lung* ICD-9 527 salivary gland diseases*
ICD-9 586 renal failure nos ICD-9 922 contusion of trunk*
ICD-9 844 sprain of knee and leg* ICD-9 070 viral hepatitis*
ICD-9 444 arterial embolism* ICD-9 577 diseases of pancreas*
ICD-9 185 malign neopl prostate ICD-9 923 contusion of upper limb*
ICD-9 701 oth skin hypertro/atroph* ICD-9 V49 limb problem/problem nec*
ICD-9 V41 prob w special functions* ICD-9 846 sprain sacroiliac region*
ICD-9 555 regional enteritis* ICD-9 179 malig neopl uterus nos
ICD-9 199 malignant neoplasm nos* ICD-9 381 nonsuppur otitis media*
ICD-9 682 other cellulitis/abscess* ICD-9 471 nasal polyps*
ICD-9 725 polymyalgia rheumatica ICD-9 V10 hx of malignant neoplasm*
ICD-9 781 nerv/musculskel sys symp* ICD-9 V43 organ replacement nec*
ICD-9 135 sarcoidosis ICD-9 364 iris/ciliary body dis*
ICD-9 836 dislocation of knee* ICD-9 288 wbc disorders*
ICD-9 466 ac bronchitis/bronchiol* ICD-9 348 other brain conditions*
ICD-9 340 multiple sclerosis ICD-9 515 postinflam pulm fibrosis
ICD-9 573 oth liver disorders* ICD-9 198 s malig neo oth sites*
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ICD-9 251 oth pancreatic disorder* ICD-9 384 disord tympanic memb nec*
ICD-9 470 deviated nasal septum ICD-9 201 hodgkin’s disease*
ICD-9 717 internal derangemnt knee* ICD-9 697 lichen*
ICD-9 170 mal neo bone/artic cart* ICD-9 225 benign neo nervous syst*
ICD-9 358 myoneural disorders* ICD-9 461 acute sinusitis*
ICD-9 921 contusion eye and adnexa* ICD-9 992 effect of heat/light*
ICD-9 374 disorders of eyelids nec* ICD-9 757 congen skin anomalies*
ICD-9 505 pneumoconiosis nos ICD-9 099 other venereal disease*
ICD-9 571 chr liver dis/cirrhosis* ICD-9 154 malig neo rectum/anus*
ICD-9 229 benign neoplasm nec/nos* ICD-9 157 malignant neo pancreas*
ICD-9 356 hered periph neuropathy* ICD-9 323 encephalomyelitis*
ICD-9 756 oth musculoskelet anomal* ICD-9 336 spinal cord disease nec*
ICD-9 203 multiple myeloma et al.* ICD-9 411 oth ac ischemic hrt dis*
ICD-9 920 contusion face/scalp/nck ICD-9 482 oth bacterial pneumonia*
ICD-9 345 epilepsy* ICD-9 691 atopic dermatitis*
ICD-9 373 inflammation of eyelids* ICD-9 186 malign neopl testis*
ICD-9 257 testicular dysfunction* ICD-9 357 inflam/toxic neuropathy*
ICD-9 277 metabolism dis nec/nos* ICD-9 949 burn unspecified*
ICD-9 601 prostatic inflammation* ICD-9 207 other specified leukemia*
ICD-9 V54 oth orthopedic aftercare* ICD-9 359 muscular dystrophies*
ICD-9 038 septicemia* ICD-9 928 crushing injury of leg*
ICD-9 155 malignant neoplasm liver* ICD-9 224 benign neoplasm of eye*
ICD-9 189 mal neo urinary nec/nos* ICD-9 508 resp cond d/t ext agent*
ICD-9 191 malignant neoplasm brain* ICD-9 694 bullous dermatoses*
ICD-9 195 mal neo oth/ill-def site* ICD-9 732 osteochondropathies*
ICD-9 371 corneal opacity/disorder* ICD-9 915 superficial inj finger*
ICD-9 583 nephritis nos* ICD-9 990 effects radiation nos
ICD-9 952 spinal cord inj w/o fx* ICD-9 370 keratitis*
ICD-9 377 disorders of optic nerve* ICD-9 397 endocardial disease nec*
ICD-9 730 osteomyelitis* ICD-9 483 pneumonia: organism nec*
ICD-9 353 nerve root/plexus dis* ICD-9 171 mal neo soft tissue*
ICD-9 423 oth pericardial disease* ICD-9 284 aplastic anemia*
ICD-9 088 oth arthropod-borne dis* ICD-9 581 nephrotic syndrome*
ICD-9 133 acariasis* ICD-9 641 antepart hem and plac prev*
ICD-9 245 thyroiditis* ICD-9 770 oth nb respiratory cond*
ICD-9 253 pituitary/hypothalm dis* ICD-9 956 inj periph nerv pelv/leg*
ICD-9 322 meningitis, unspecified*
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