J Rheum Dis.  2014 Apr;21(2):64-73. 10.4078/jrd.2014.21.2.64.

Prediction for TNF Inhibitor Users in RA Patients According to Reimbursement Criteria Based on DAS28

• Won S
• Sung YK
• Cho SK
• Choi CB
• Koh EM
• Kim SK
• Kim J
• Kim TH
• Kim HA
• Nah SS
• Bang SY
• Suh CH
• Shim SC
• Yoo DH
• Yoon BY
• Lee SH
• Lee SW
• Lee SS
• Lee YA
• Lee J
• Lee J
• Lee HS
• Lim MK
• Jun JB
• Jeon CH
• Jung YO
• Chung WT
• Cha HS
• Choe JY
• Hong SJ
• Bae SC

• KMID: 2094659
• DOI: http://doi.org/10.4078/jrd.2014.21.2.64

Abstract

OBJECTIVE
The purpose of this study is to examine the difference between the numbers of patients in rheumatoid arthritis (RA) who are eligible to TNF inhibitors by the past Korean National Health Insurance reimbursement guideline and by the disease activity score with 28-joint assessment (DAS28) based criteria.
METHODS
Data were obtained from a multi-center registry for biologics users in Korean RA patients, BIOlogics Pharmacoepidemiologic StudY (BIOPSY). DAS28 was calculated based on either ESR or CRP, and DAS28 of more than 5.1 or between 3.2 and 5.1 with radiographic changes was defined as a cut-off point for the initiation of TNF inhibitors. For the maintenance criteria, we used both of improving in DAS28 score (>1.2) and low disease activity (DAS 28<3.2). Differences between the numbers in each step by two criteria were described with Chi-square test and Kappa agreement.
RESULTS
Of the 489 patients in BIOPSY, 299 were included in this study. Among them, 278 patients (93.0%) were eligible of TNF inhibitors when we applied the new initiation criteria with DAS28-ESR, and 244 patients (81.6%) were indicated for TNF inhibitors with DAS28-CRP. For the maintenance criteria, a low disease activity (DAS28<3.2) in 3 months after starting TNF inhibitors is too strict for achieving (33.6% with DAS28-ESR and 50.0% with DAS28-CRP). Instead, decreasing DAS28 by more than 1.2 is more reasonable as a tool for deciding early responsiveness of TNF inhibitors in RA patients (81.2% both with DAS28-ESR and DAS28-CRP).
CONCLUSION
Our results show that the candidates for TNF inhibitors will be enormously changed according to a change in the reimbursement criteria. To define appropriate patients to receive TNF inhibitors, a further study with regard to the impact of changes in the reimbursement criteria on the outcomes of RA patients will be required.

Keyword

Korean National Health Insurance reimbursement criteria; Rheumatoid arthritis; TNF inhibitor; DAS28

MeSH Terms

Arthritis, Rheumatoid
Biological Products
Biopsy
Humans
National Health Programs
Biological Products

Figure

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  Figure 1. Derivation of samples for study.

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