류마티스관절염에서 DAS28에 근거한 보험급여기준 적용시 항 TNF제제 대상 환자 예측open accessPrediction for TNF Inhibitor Users in RA Patients According to Reimbursement Criteria Based on DAS28
- Other Titles
- Prediction for TNF Inhibitor Users in RA Patients According to Reimbursement Criteria Based on DAS28
- Authors
- 원소영; 성윤경; 조수경; 최찬범; 고은미; 김성규; 김진석; 김태환; 김현아; 나성수; 방소영; 서창희; 심승철; 유대현; 윤보영; 이상훈; 이성원; 이신석; 이연아; 이재준; 이지수; 이혜순; 임미경; 전재범; 전찬홍; 정영옥; 정원태; 차훈석; 최정윤; 홍승재; 배상철
- Issue Date
- Apr-2014
- Publisher
- 대한류마티스학회
- Keywords
- Korean National Health Insurance reimbursement criteria; Rheumatoid arthritis; TNF inhibitor; DAS28
- Citation
- 대한류마티스학회지, v.21, no.2, pp.64 - 73
- Indexed
- KCI
- Journal Title
- 대한류마티스학회지
- Volume
- 21
- Number
- 2
- Start Page
- 64
- End Page
- 73
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/25902
- DOI
- 10.4078/jrd.2014.21.2.64
- ISSN
- 2093-940X
- 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.
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