노인 류마티스 관절염 환자에서의 요양급여심사기준 변경에 따른 TNF-α 억제제 약물사용양상 = The Effect of a Change in Reimbursement Criteria on the Utilization of Tumor Necrosis Factor-α Inhibitors in Elderly Patients with Rheumatoid Arthritis in Korea

다국어 초록 (Multilingual Abstract)

In January 2014, there was a change in the reimbursement criteria of TNF-α inhibitor (TNFi) for RA patients. The new reimbursement criteria require DAS28 of a patient to assess disease activity, while previous reimbursement criteria required laboratory data and several subjective assessments. We examined the effect of a change in reimbursement criteria on the utilization of TNFi in RA patients. Data sources were 2013-2014 Aged Patient Sample data of Health Insurance Review and Assessment. Monthly trends in prescription and consumption of TNFi were estimated using segmented regression of interrupted time series. The consumption of TNFi was measured in terms of Daily Defined Dose per 1,000 RA patients per day. Subgroup analysis was conducted by the types of institution. There were increased baseline trends in prescription and consumption of TNFi, which were not significant. In subgroup analysis, tertiary hospital showed a significant increase in prescription and consumption immediately after the change in reimbursement criteria, while general hospital, hospital, and clinic showed a significant decrease in prescription and consumption. These trends were consistent throughout one year after the change in reimbursement criteria. This study shows that the change in reimbursement criteria of TNFi in RA patients had little impact on the overall utilization of TNFi. However, the change in reimbursement criteria significantly affected the pattern of TNFi utilization by the types of institution. Further research is needed to examine whether this change improved the accessibility to TNFi in RA patients.

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