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Electronic healthcare databases in Europe: descriptive analysis of characteristics and potential for use in medicines regulation
  1. Alexandra Pacurariu1,
  2. Kelly Plueschke1,
  3. Patricia McGettigan1,2,
  4. Daniel R Morales1,3,
  5. Jim Slattery1,
  6. Dagmar Vogl1,
  7. Thomas Goedecke1,
  8. Xavier Kurz1,
  9. Alison Cave1
  1. 1 Department of Surveillance and Epidemiology Service, European Medicines Agency, London, UK
  2. 2 William Harvey Research Institute, Queen Mary University of London, London, UK
  3. 3 Division of Population Health Sciences, University of Dundee, Dundee, UK
  1. Correspondence to Alexandra Pacurariu; alexandra.pacurariu{at}ema.europa.eu

Abstract

Objective Electronic healthcare databases (EHDs) are useful tools for drug development and safety evaluation but their heterogeneity of structure, validity and access across Europe complicates the conduct of multidatabase studies. In this paper, we provide insight into available EHDs to support regulatory decisions on medicines.

Methods EHDs were identified from publicly available information from the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance resources database, textbooks and web-based searches. Databases were selected using criteria related to accessibility, longitudinal dimension, recording of exposure and outcomes, and generalisability. Extracted information was verified with the database owners.

Results A total of 34 EHDs were selected after applying key criteria relevant for regulatory purposes. The most represented regions were Northern, Central and Western Europe. The most frequent types of data source were electronic medical records (44.1%) and record linkage systems (29.4%). The median number of patients registered in the 34 data sources was 5 million (range 0.07–15 million) while the median time covered by a database was 18.5 years. Paediatric patients were included in 32 databases (94%). Completeness of information on drug exposure was variable. Published validation studies were found for only 17 databases (50%). Some level of access exists for 25 databases (73.5%), and 23 databases (67.6%) can be linked through a personal identification number to other databases with parent–child linkage possible in 7 (21%) databases. Eight databases (23.5%) were already transformed or were in the process of being transformed into a common data model that could facilitate multidatabase studies.

Conclusion A Few European databases meet minimal regulatory requirements and are readily available to be used in a regulatory context. Accessibility and validity information of the included information needs to be improved. This study confirmed the fragmentation, heterogeneity and lack of transparency existing in many European EHDs.

  • electronic healthcare databases
  • post-authorisation studies
  • regulatory science
  • benefit-risk evaluation
  • real-world data

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors All authors (AP, KP,PMG, DRM, JS, DV, TG, XK and AC) were involved in the study design and data collection. AP, XK and DRM performed the analysis and interpretation of results. AP, DRM and AC contributed to writing and KP, PMG, JS, TG and XK revised and approved the final draft.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed in this article are the personal views of the authors and may not be understood or quoted as being made on behalf of or reflecting the position of the European Medicines Agency or one of its committees or working parties.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement An extended version of the dataset is available as supplementary material.

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