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

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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.

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Acknowledgments

This study was supported by Janssen Korea Ltd.

Funding

This study was supported by Janssen Korea Ltd.

Author information

Authors and Affiliations

  1. Eulji General Hospital, Seoul, Korea

    Jin-Wuk Hur

  2. Daegu Catholic University Medical Center, Daegu, Korea

    Jung-Yoon Choe

  3. Inje University Busan Paik Hospital, Busan, Korea

    Dong-Wook Kim

  4. Hallym University Sacred Heart Hospital, Anyang, Korea

    Hyun Ah Kim

  5. Keimyung University Dongsan Hospital, Daegu, Korea

    Sang-Hyon Kim

  6. Catholic University of Korea Seoul St. Mary’s Hospital, Seoul, Korea

    Wan-Uk Kim

  7. Chosun University Hospital, Gwangju, Korea

    Yun Sung Kim

  8. Hanyang University Guri Hospital, Guri, Korea

    Hye-Soon Lee

  9. Konkuk University Medical Center, Seoul, Korea

    Sang-Heon Lee

  10. Catholic University of Korea Seoul St. Mary’s Hospital, Seoul, Korea

    Sung-Hwan Park

  11. Inha University Hospital, Incheon, Korea

    Won Park

  12. Yonsei University Severance Hospital, Seoul, Korea

    Yong-Beom Park

  13. Ajou University Hospital, Suwon, Korea

    Chang-Hee Suh

  14. Chungnam National University Hospital, Daejeon, Korea

    Seung-Cheol Shim

  15. Seoul National University Hospital, Seoul, Korea

    Yeong-Wook Song

  16. Inje University Ilsan Paik Hospital, Ilsan, Korea

    Bo Young Yoon

  17. Janssen Korea, Medical Affairs, Seoul, Korea

    Dae Young Yu

  18. Division of Rheumatology, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, South Korea

    Dae Hyun Yoo

Authors
  1. Jin-Wuk Hur
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  2. Jung-Yoon Choe
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  3. Dong-Wook Kim
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  4. Hyun Ah Kim
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  6. Wan-Uk Kim
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  7. Yun Sung Kim
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  8. Hye-Soon Lee
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  9. Sang-Heon Lee
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  10. Sung-Hwan Park
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  11. Won Park
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  12. Yong-Beom Park
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  13. Chang-Hee Suh
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  14. Seung-Cheol Shim
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  15. Yeong-Wook Song
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  16. Bo Young Yoon
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  17. Dae Young Yu
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  18. Dae Hyun Yoo
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Corresponding author

Correspondence to Dae Hyun Yoo.

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Conflict of interest

Jin-Wuk Hur, Jung-Yoon Choe, Dong-Wook Kim, Sang-Hyon Kim, Wan-Uk Kim, Yun Sung Kim, Hye-Soon Lee, Sang-Heon Lee, Sung-Hwan Park, Yong-Beom Park, Chang-Hee Suh, Seung-Cheol Shim, Yeong-Wook Song and Bo Young Yoon declare that they have no conflict of interest. Hyun Ah Kim has served on advisory boards for Hanmi-Pharmaceutical and Pfizer. Won Park and Dae Hyun Yoo are scientific consultants for Celltrion. Dae Young Yu is an employee of Janssen.

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Hur, JW., Choe, JY., Kim, DW. et al. Rheumatoid arthritis patients fulfilling Korean National Health Insurance reimbursement guidelines for anti-tumor necrosis factor-α treatment and comparison to other guidelines. Rheumatol Int 35, 1817–1823 (2015). https://doi.org/10.1007/s00296-015-3353-7

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  • DOI: https://doi.org/10.1007/s00296-015-3353-7

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