Rheumatoid arthritis patients fulfilling Korean National Health Insurance reimbursement guidelines for anti-tumor necrosis factor-α treatment and comparison to other guidelines.
The aim of this study was to compare anti-tumor necrosis factor-α (TNFα) treatment status in rheumatoid arthritis (RA) patients with the Korean National Health Insurance (KNHI) reimbursement eligibility criteria and with American College of Rheumatology (ACR) recommendations, Japan College of Rheumatology (JCR) guidelines and British Society for Rheumatology (BSR) guidelines. Between December 2011 and August 2012, outpatients from 17 South Korean general hospitals diagnosed with RA according to the 1987 ACR criteria were enrolled into a noninterventional, cross-sectional, observational study. Of 1700 patients (1414 female (83.2 %), mean age of 56.6 ± 12.0, mean disease duration 97.9 ± 91.8 months), 306 (18.0 %) had used anti-TNFα agents, and 224 (13.2 %) were currently using an anti-TNFα agent. Of 1394 anti-TNFα-naive patients, 32 (2.3 %) met KNHI reimbursement guidelines, 148 (10.6 %) met ACR recommendations, and 127 (9.1 %) and 126 (9.0 %) were considered eligible for anti-TNFα agents according to JCR and BSR guidelines, respectively. The main discrepancy was the higher active joint count required by the KNHI eligibility criteria. In the opinion of treating rheumatologists, the KNHI reimbursement criteria ineligibility accounted for 15.3 % (n = 213) of the reasons for not initiating anti-TNFα agents in anti-TNFα-naive group. The anti-TNFα user group showed significantly higher disease activity than the anti-TNFα-naive group based on DAS28 score. In comparison with the ACR recommendations and JCR and BSR guidelines, fewer patients met KNHI reimbursement eligibility criteria for anti-TNFα agents. The current amendment of the KNHI criteria based on DAS28 score will improve an access to biologic agents including anti-TNFα treatment for South Korean patients with active RA.
Eulji General Hospital, Seoul, Korea.
Jin-Wuk
JW
Hur
Daegu Catholic University Medical Center, Daegu, Korea.
Jung-Yoon
JY
Choe
Inje University Busan Paik Hospital, Busan, Korea.
Dong-Wook
DW
Kim
Hallym University Sacred Heart Hospital, Anyang, Korea.
Hyun Ah
HA
Kim
Keimyung University Dongsan Hospital, Daegu, Korea.
Sang-Hyon
SH
Kim
Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea.
Wan-Uk
WU
Kim
Chosun University Hospital, Gwangju, Korea.
Yun Sung
YS
Kim
Hanyang University Guri Hospital, Guri, Korea.
Hye-Soon
HS
Lee
Konkuk University Medical Center, Seoul, Korea.
Sang-Heon
SH
Lee
Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea.
Sung-Hwan
SH
Park
Inha University Hospital, Incheon, Korea.
Won
W
Park
Yonsei University Severance Hospital, Seoul, Korea.
Yong-Beom
YB
Park
Ajou University Hospital, Suwon, Korea.
Chang-Hee
CH
Suh
Chungnam National University Hospital, Daejeon, Korea.
Seung-Cheol
SC
Shim
Seoul National University Hospital, Seoul, Korea.
Yeong-Wook
YW
Song
Inje University Ilsan Paik Hospital, Ilsan, Korea.
Bo Young
BY
Yoon
Janssen Korea, Medical Affairs, Seoul, Korea.
Dae Young
DY
Yu
Division of Rheumatology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea. dhyoo@hanyang.ac.kr.
Dae Hyun
DH
Yoo
D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000276:immunology; D003430:Cross-Sectional Studies; D016527:Drug Costs; D017723:Drug Utilization Review; D004608:Eligibility Determination / Q000191:economics* / Q000592:standards; D005260:Female; D019983:Guideline Adherence / Q000191:economics; D006769:Hospitals, General / Q000191:economics; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000592:standards; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics* / Q000592:standards; D017410:Practice Guidelines as Topic; D056910:Republic of Korea; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors* / Q000276:immunology
D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha
Anti-TNFα agents; Reimbursement guidelines; Rheumatoid arthritis; Treatment