The Impact of the Amendment of the Korean National Health Insurance Reimbursement Criteria for Anti-tumor Necrosis Factor- alpha Agents on Treatment Pattern, Clinical Response and Persistence in Patients With Rheumatoid Arthritis

Abstract

Objective. To investigate the impact of the amendment of the Korean National Health Insurance (KNHI) reimbursement criteria for anti-tumor necrosis factor-alpha (TNF-alpha) agents based on from conventional clinical and laboratory measurements to disease activity score of 28 joints (DAS28) on treatment pattern, clinical response, and persistence rate in patients with rheumatoid arthritis (RA). Methods. This multicenter retrospective cohort study evaluated 148 RA patients eligible for the initiation of anti-TNF-alpha agents as the first-line biologics by either the past (n=95) or current (n=53) KNHI reimbursement criteria. Persistence was defined as the duration between the initiation and discontinuation of anti-TNF alpha agents. Results. In total, 106 (71.6%), 35 (23.6%), and 7 (4.7%) RA patients started treatment with adalimumab, etanercept, and infliximab, respectively. RA patients who received anti-TNF- alpha agents under the current reimbursement criteria had a significantly lower mean DAS28-erythrocyte sedimentation rate (ESR) (6.02 vs. 6.95, p<0.001) and daily prednisolone-equivalent glucocorticoid dose (4.51 vs. 6.17 mg, p<0.001) than those who received anti-TNF-alpha agents under the past reimbursement criteria. No significant differences in the 1-year remission rate defined by DAS28-ESR<2.6 (17.9% vs. 30.2%, p=0.085) and the persistence rate (p=0.703) between the past and current reimbursement criteria was observed. Conclusion. Our data suggest that less active RA patients can receive reimbursement for anti-TNF-alpha agents under the current criteria, and the amendment of the KNHI reimbursement criteria may improve access to anti-TNF-alpha agents without affecting the treatment response and persistence rate.