title: Belgian rheumatologists' perception on eligibility of RA patients for anti-TNF treatment matches more closely Dutch rather than Belgian reimbursement criteria.
abstract: OBJECTIVE
  To assess discrepancies between perception of Belgian rheumatologists on eligibility of RA patients for anti-TNF treatment and Belgian reimbursement criteria and to compare Belgian with Dutch criteria and UK guidelines.
  
  
  METHODS
  Consecutive MTX-experienced patients with active RA were recruited from 25 private and academic rheumatology practices. Discrepancies between eligibility for anti-TNF treatment according to the rheumatologist and fulfillment of Belgian reimbursement criteria [HAQ > or =25%, tender joint count (TJC) and swollen joint count (SJC) > or =8; > or =1 erosion; failure of > or =2 DMARDs including MTX; no tuberculosis] were recorded. Reasons for failing the Belgian criteria and results of applying Dutch reimbursement criteria and UK guidelines on the dataset were analysed.
  
  
  RESULTS
  Of 492 patients, rheumatologists considered 135 (27.4%) as eligible, whereas Belgian criteria were fulfilled for only 34 (6.9%). Positive predictive value (PPV) of rheumatologists' perception on eligibility for fulfillment of Belgian criteria was 22.9%, whereas negative predictive value (NPV) was 99.1%. The 104 patients (21.1%) considered eligible despite criteria not being fulfilled had significantly greater TJCs, SJCs, disease activity score (DAS28) and Rheumatoid Arthritis Disease Activity Index scores than the 385 patients (78.2%) in the no-discrepancy group. Number of swollen joints, HAQ and erosions mainly accounted for discrepancies. Of 492 patients, 263 (53.4%) qualified for Dutch criteria and 41 (8.3%) for UK guidelines. PPV of Belgian rheumatologists' perception was 72.6% for fulfilling Dutch criteria (NPV 49.6%) and 23.4% for UK guidelines (NPV 96.7%).
  
  
  CONCLUSIONS
  Rheumatologists consider more RA patients eligible for anti-TNF treatment than would be reimbursed according to Belgian criteria. Dutch guidelines, based on DAS28, match more closely eligibility according to Belgian rheumatologists.
authors.affiliation: Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Elke
authors.initials: E
authors.lastname: Geens
authors.forename: Piet
authors.initials: P
authors.lastname: Geusens
authors.forename: Johan
authors.initials: J
authors.lastname: Vanhoof
authors.forename: Hubert
authors.initials: H
authors.lastname: Berghs
authors.forename: Johan
authors.initials: J
authors.lastname: Praet
authors.forename: Greet
authors.initials: G
authors.lastname: Esselens
authors.forename: Simonne
authors.initials: S
authors.lastname: Lens
authors.forename: Jean-Pol
authors.initials: JP
authors.lastname: Dufour
authors.forename: Marc
authors.initials: M
authors.lastname: Vandenberghe
authors.forename: Xavier
authors.initials: X
authors.lastname: Van Mullem
authors.forename: René
authors.initials: R
authors.lastname: Westhovens
authors.forename: Patrick
authors.initials: P
authors.lastname: Verschueren
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D001530:Belgium; D004608:Eligibility Determination; D006801:Humans; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012051:Reimbursement Mechanisms; D012720:Severity of Illness Index; D017211:Treatment Failure; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D006113:United Kingdom
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha