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Table 2 Methodology and results of the retrospective studies included in a literature review of drug sales data analyses for surveillance of infectious diseases

From: Drug sales data analysis for outbreak detection of infectious diseases: a systematic literature review

Author Syndrome Reference data sources Drugs selected Statistical methods Correlation strength Correlation timeliness Detection sensitivity Detection specificity Detection timeliness
STUDIES ON PRESCRIBED DRUGS
Sugawara et al. [27] 2012 ILI Influenza cases from 5000 hospitals and clinics Drugs against influenza virus : oseltamivir, zanamivir, laninamivir Correlation Pearson corr. coeff. r = 0.992 for 2009/10 and r = 0.972 for 2010/11 (p<0.001) - - - -
Polgreen et al. [23] 2011 GI Hospitalizations with diagnosis of Clostridium Difficile Infections Oral vancomycin Cross-correlation, Regression model Increase in Clostridium Difficile Infections associated with increase in vancomycin use - - - -
Chopra et al. [12] 2011 ILI Cases of influenza reported from nine sentinel healthcare providers Oseltamivir Correlation Spearman corr.coeff. r = 0.46 (p<0.003) Peaks occurred at the same time - - - -
Yoshida et al. [30] 2009 ILI 28 sentinel surveillance sites of influenza in Sahai City (clinics and hospitals) Oseltamivir and Zanamivir Correlation Pearson corr.coeff. r = 0.954 - - - -
Van den Wijngaard et al. [28] 2008 ILI Respiratory pathogen diagnosis in laboratory registries (Influenza A, B, RSV, enterovirus, S.pneumoniae..) Drugs for respiratory infectious diseases (7 ATC classes) Graphical comparison, Correlation, Linear regression model Pearson corr .coeff. r = 0.60 for Influenza A, r = 0.58 for RSV, r = 0.60 for S. pneumonia, r = 0.39 for influenza B (p<0.05) 80% of variation explained by respiratory pathogens 2 weeks earlier until 1 week later - - -
Author Syndrome Reference data sources Drugs selected Statistical methods Correlation strength Correlation timeliness Detection sensitivity Detection specificity Detection timeliness
Chen et al. [11] 2005 Pertussis Reported cases of pertussis from the NYS department of Health Macrolide antibiotics CUSUM - - 100% The signal was indicator of pertussis outbreak 100% Not early warning
Couturier et al. [13] 2004 Syphilis Reported cases of syphilis from hospitals, physicians, sexually transmitted disease clinics. Benzylpenicillin benzathine 2.4 MUI Descriptive analysis Similar trend (+22% increase in Paris, +10% in the 5 regions) Similar trend - - -
STUDIES ON OTC DRUGS
Kirian et al. [19] 2010 GI Cases of gastrointestinal diseases from County Health Department and detected GI outbreaks Diarrheal remedies (based on common use) Cross-correlation, Regression ARIMA No significant correlation between sales and GI cases counts, outbreak counts. - Not sensitive 4%-14% Specific 97%-100% -
Edge et al. [17] 2006 GI Counts of GI cases due to bacteria, parasites, and viruses Antinauseant and antidiarrheal products Cross-correlation Temporal patterns of OTC and Norovirus activity were similar Pearson r2 = 0.44 No delay - - -
Okhusa et al. [22] 2005 ILI Reporting of patients with ILI (hospitals, clinics, physicians) Most common treatments ILI Cross-correlation, Prediction model, Peak comparison Significant correlation between sales and influenza activity Sales do not determine influenza in advance - - -
Das et al. [14] 2005 ILI Emergency department in New York City (ratio of ILI syndrome visits/other syndrome visits) A cold medication selected statistically from a group of 400 cold medications (ratio ILI/analgesics drugs sales) Cross-correlation, Serfling method, Graphical comparison High correlation Pearson r2 = 0.60 (p<0.001) No lead time Sensitive (data not reported) Not specific (not reported) Not earlier warning than reference data
Das et al. [14] 2005 GI Emergency department in New York City (ratio of GI syndrome visits/other syndrome visits) Common antidiarrheal drugs(ratio GI/analgesic drug sales) Cross-correlation, Graphical comparison Low correlation Pearson r2 = 0.24 (p<0.005) Similar increases during the fall (norovirus) and influenza peak. Increase in ED GI visits during late winter (rotavirus), but no increase in drug sales. - Less sensitive than ED system - -
Author Syndrome Reference data sources Drugs selected Statistical methods Correlation strength Correlation timeliness Detection sensitivity Detection specificity Detection timeliness
Edge et al. [16] 2004 GI Emergency room visits for acute GI, number of GI cases from case series investigations (waterborne outbreak) Saskatchewan: four commonly used antidiarrheals and antinauseants Ontario: 12 products (antidiarrheal, antinauseant, rehydration products) Graphical comparison(Ontario, Saskatchewan), CUSUM, moving average (Ontario) Trends of OTC products comparable to the outbreak epidemic curve (Saskatchewan,Ontario) - 100% exceeded threshold during the outbreak period (Ontario) 100% Not earlier
Magruder et al. [21] 2004 ILI Outpatient insurance-claim diagnoses for acute respiratory conditions, from 13,000 clinics and doctors’ offices Remedies for treating influenza (common use) Cross-correlation Seasonal trend: Pearson r (between 0.95 and 0.99) 1- 3 week lead - - -
      Non-seasonal trend: Pearson r (between 0.25 and 0.75) No repeatable lead time    
Hogan et al. [18] 2003 ILI and GI Hospital-discharge diagnoses of respiratory and diarrheal disease in children (for all hospitals in Pennsylvania, in Utah, and 95% of Indiana). Electrolyte products Cross-correlation, EWMA Pearson r = 0.90 (95% CI, 0.87-0.93) Sales preceded diagnoses by 1.7 weeks (95% CI, 0.50-2.9) 100% 100% Electrolyte sales preceded detection from diagnoses by an average of 2.4 weeks (95% CI, 0.1-4.8) Detection earlier in 12/18 outbreaks
Magruder [20] 2003 ILI Outpatient insurance-claim diagnoses for acute respiratory conditions Cold remedies: 622 products (then grouped in categories by an expert in pharmacoepidemiology) Cross-correlation Pearson r = 0.9 Mean lead times of 2.8 days - - -
Davies et al. [15] 2003 ILI Emergency admission data from Nottingham City Hospital NHS Trust. Cold and flu remedies (cold, cough, decongestant, throat preparation) Correlation, Peak comparison, Threshold detection method National and local sales positively correlated with admissions in 98/99 and 99/00, not 00/01 - 100%(for local sales) 100% (for local sales) Rate of local sales exceed threshold of 1000 units per week 2 weeks prior to peak in emergency admissions
Author Syndrome Reference data sources Drugs selected Statistical methods Correlation strength Correlation timeliness Detection sensitivity Detection specificity Detection timeliness
Stirling et al. [26] 2001 GI Telephone survey from a sample of households: number of persons with diarrheal symptoms and/or with stool specimen positive to C. parvum oocysts. (waterborne outbreak) Common antidiarrheal (determined by each pharmacist) Descriptive analysis A fivefold increase in sales during the epidemic period - - - -
Proctor et al. [24] 1998 GI Comparison with eight sources (laboratory confirmed cases of Cryptosporidium, clinically defined cases) (waterborne outbreak) Antidiarrheal: Imodium, Pepto Bismol, Kaopectate Descriptive analysis Significant increase in drug sales during epidemic period - - - -
Rodman et al. [25] 1997 GI Cases of cryptosporidiosis (5 waterborne outbreaks) Antidiarrheal drugs Descriptive analysis Milkauwee: increased 20 fold; Las Vegas: no data; Collingwood: increased in 2 of 3 stores;Kelowna: increased 3 fold;Cranbrook: increased - - - -
Welliver et al. [29] 1979 ILI Laboratory count of influenza B Children’s aspirin, adult antipyretics, cold remedies Determination of the% of sales increase, peak comparison Sales of cold remedies averaged 185% above the baseline value during the peak influenza activity - - - -
  1. Abbreviations: ILI Influenza-like illness, GI Gastrointestinal, RSV Respiratory syncytial virus, ATC Anatomical Therapeutic Chemical classification system, CUSUM Cumulative sum control chart, OTC Over-the-counter drugs, EWMA Exponentially Weighted Moving Average.