J Rheum Dis.  2012 Dec;19(6):334-340. 10.4078/jrd.2012.19.6.334.

Comparison Korean National Health Insurance Reimbursement and Other Guidelines for TNF-alpha Blocker in Rheumatoid Arthritis

Affiliations
  • 1Division of Rheumatology, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea. kimha@hallym.ac.kr

Abstract


OBJECTIVE
The aim of this study was to examine how many Korean rheumatoid arthritis (RA) patients fulfilling the 2008 American College of Rheumatology (ACR) recommendation, 2007 British Society for Rheumatology (BSR) guideline and 2010 Japan College of Rheumatology (JCR) guideline for TNF-alpha blocker, meet the Korean National Health Insurance reimbursement criteria and to evaluate the reasons for failing the Korean National Health Insurance reimbursement criteria.
METHODS
Data were obtained from a registry of RA patients who visited rheumatology clinics of Hallym university affiliated hospitals. Patients who were previously prescribed with methotrexate or leflunomide for more than 3 months and had at least one DAS28 examination were included in the present study.
RESULTS
Of 642 patients included, 118 episodes meeting ACR guideline for using TNF-alpha blocker were identified in 88 patients (13.7%). In addition, 19 episodes meeting BSR guideline in 17 patients (2.6%) and 21 episodes meeting JCR guideline in 21 patients (6.2%) were identified. Four episodes (4.8%) meeting ACR recommendation, 0 episodes meeting BSR criteria and 5 episodes (12%) meeting JCR criteria, respectively, were eligible for TNF-alpha blocker according to the Korean National Health Insurance reimbursement guideline. The most common reason for failing the Korean National Health Insurance reimbursement criteria was the number of active joint counts (92.6%).
CONCLUSION
Our results show that the majority of RA patients satisfying the ACR guideline, BSR and JCR guideline for use of the TNF-alpha blocker did not meet the Korean National Health Insurance reimbursement criteria. Patients most often failed due to active joint count criteria.

Keyword

Korean National Health Insurance reimbursement criteria; Rheumatoid arthritis; TNF-alpha blocker

MeSH Terms

Arthritis, Rheumatoid
Humans
Isoxazoles
Japan
Joints
Methotrexate
National Health Programs
Rheumatology
Tumor Necrosis Factor-alpha
Isoxazoles
Methotrexate
Tumor Necrosis Factor-alpha

Figure

  • Figure 1 Recruitment of rheumatoid arthritis (RA) study participants. MTX: Methotrexate, LFN: Leflumonide, DAS28: Disease activity score 28, ACR: American College of Rheumatology, BSR: British Society for Rheumatology, JCR: Japan College of Rheumatology.

  • Figure 2 Responses to questionnaires about the Korean National Health Insurance reimbursement criteria for TNF-α blocker in patients with rheumatoid arthritis. (A) Overall rating on the Korean National Health Insurance reimbursement criteria (B) Each reimbursement criteria selected as the most unreasonable. *Acute phase reactant: ESR≥28 mm/hr or CRP≥2 mg/dL, †Morning stiffness: more than 45 minutes, ‡Active joint count: more than 20 total active joint counts or total 6 active joint counts with more 4 active joint count in large joints, §Previous treatment Hx: inadequate control despite treatment for at least 3 months respectively with 2 more DMARDs.


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