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

Jin Wuk Hur, Jung Yoon Choe, Dong Wook Kim, Hyun Ah Kim, Sang Hyon Kim, Wan Uk Kim, Yun Sung Kim, Hye Soon Lee, Sang Heon Lee, Sung Hwan Park, Won Park, YongBeom Park, Chang Hee Suh, Seung Cheol Shim, Yeong Wook Song, Bo Young Yoon, Dae Young Yu, Dae Hyun Yoo

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Abstract

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.

Original languageEnglish
Pages (from-to)1817-1823
Number of pages7
JournalRheumatology International
Volume35
Issue number11
DOIs
Publication statusPublished - 2015 Nov 1

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Health Insurance Reimbursement
National Health Programs
Rheumatoid Arthritis
Rheumatology
Tumor Necrosis Factor-alpha
Guidelines
Therapeutics
Japan
Biological Factors
General Hospitals
Observational Studies
Outpatients
Cross-Sectional Studies
Joints

All Science Journal Classification (ASJC) codes

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

Hur, Jin Wuk ; Choe, Jung Yoon ; Kim, Dong Wook ; Kim, Hyun Ah ; Kim, Sang Hyon ; Kim, Wan Uk ; Kim, Yun Sung ; Lee, Hye Soon ; Lee, Sang Heon ; Park, Sung Hwan ; Park, Won ; Park, YongBeom ; Suh, Chang Hee ; Shim, Seung Cheol ; Song, Yeong Wook ; Yoon, Bo Young ; Yu, Dae Young ; Yoo, Dae Hyun. / Rheumatoid arthritis patients fulfilling Korean National Health Insurance reimbursement guidelines for anti-tumor necrosis factor-α treatment and comparison to other guidelines. In: Rheumatology International. 2015 ; Vol. 35, No. 11. pp. 1817-1823.
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title = "Rheumatoid arthritis patients fulfilling Korean National Health Insurance reimbursement guidelines for anti-tumor necrosis factor-α treatment and comparison to other guidelines",
abstract = "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.",
author = "Hur, {Jin Wuk} and Choe, {Jung Yoon} and Kim, {Dong Wook} and Kim, {Hyun Ah} and Kim, {Sang Hyon} and Kim, {Wan Uk} and Kim, {Yun Sung} and Lee, {Hye Soon} and Lee, {Sang Heon} and Park, {Sung Hwan} and Won Park and YongBeom Park and Suh, {Chang Hee} and Shim, {Seung Cheol} and Song, {Yeong Wook} and Yoon, {Bo Young} and Yu, {Dae Young} and Yoo, {Dae Hyun}",
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Hur, JW, Choe, JY, Kim, DW, Kim, HA, Kim, SH, Kim, WU, Kim, YS, Lee, HS, Lee, SH, Park, SH, Park, W, Park, Y, Suh, CH, Shim, SC, Song, YW, Yoon, BY, Yu, DY & Yoo, DH 2015, 'Rheumatoid arthritis patients fulfilling Korean National Health Insurance reimbursement guidelines for anti-tumor necrosis factor-α treatment and comparison to other guidelines', Rheumatology International, vol. 35, no. 11, pp. 1817-1823. https://doi.org/10.1007/s00296-015-3353-7

Rheumatoid arthritis patients fulfilling Korean National Health Insurance reimbursement guidelines for anti-tumor necrosis factor-α treatment and comparison to other guidelines. / Hur, Jin Wuk; Choe, Jung Yoon; Kim, Dong Wook; Kim, Hyun Ah; Kim, Sang Hyon; Kim, Wan Uk; Kim, Yun Sung; Lee, Hye Soon; Lee, Sang Heon; Park, Sung Hwan; Park, Won; Park, YongBeom; Suh, Chang Hee; Shim, Seung Cheol; Song, Yeong Wook; Yoon, Bo Young; Yu, Dae Young; Yoo, Dae Hyun.

In: Rheumatology International, Vol. 35, No. 11, 01.11.2015, p. 1817-1823.

Research output: Contribution to journalArticle

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AU - Hur, Jin Wuk

AU - Choe, Jung Yoon

AU - Kim, Dong Wook

AU - Kim, Hyun Ah

AU - Kim, Sang Hyon

AU - Kim, Wan Uk

AU - Kim, Yun Sung

AU - Lee, Hye Soon

AU - Lee, Sang Heon

AU - Park, Sung Hwan

AU - Park, Won

AU - Park, YongBeom

AU - Suh, Chang Hee

AU - Shim, Seung Cheol

AU - Song, Yeong Wook

AU - Yoon, Bo Young

AU - Yu, Dae Young

AU - Yoo, Dae Hyun

PY - 2015/11/1

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N2 - 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.

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