Rheumatoid arthritis patients fulfilling Korean National Health Insurance reimbursement guidelines for anti-tumor necrosis factor-alpha treatment and comparison to other guidelines

Abstract

The aim of this study was to compare anti-tumor necrosis factor-alpha (TNF alpha) 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 +/- A 12.0, mean disease duration 97.9 +/- A 91.8 months), 306 (18.0 %) had used anti-TNF alpha agents, and 224 (13.2 %) were currently using an anti-TNF alpha agent. Of 1394 anti-TNF alpha-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-TNF alpha 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-TNF alpha agents in anti-TNF alpha-naive group. The anti-TNF alpha user group showed significantly higher disease activity than the anti-TNF alpha-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-TNF alpha agents. The current amendment of the KNHI criteria based on DAS28 score will improve an access to biologic agents including anti-TNF alpha treatment for South Korean patients with active RA.