Belgian rheumatologists’ perception on eligibility of RA patients for anti-TNF treatment matches more closely Dutch rather than Belgian reimbursement criteria

Objectives. To assess discrepancies between perception of Belgian rheumatologists on eligibility of RA patients for anti-TNF treatment and Belgian reimbursement criteria and to compare Belgian with Dutch criteria and UK guidelines. Methods. Consecutive MTX-experienced patients with active RA were re...

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Bibliographic Details
Published in:	Rheumatology (Oxford, England) Vol. 48; no. 5; pp. 546 - 550
Main Authors:	Geens, Elke, Geusens, Piet, Vanhoof, Johan, Berghs, Hubert, Praet, Johan, Esselens, Greet, Lens, Simonne, Dufour, Jean-Pol, Vandenberghe, Marc, Van Mullem, Xavier, Westhovens, René, Verschueren, Patrick
Format:	Journal Article
Language:	English
Published:	Oxford Oxford University Press 01-05-2009 Oxford Publishing Limited (England)
Subjects:	Anti-TNF treatment Antirheumatic Agents - therapeutic use Arthritis, Rheumatoid - drug therapy Arthritis, Rheumatoid - economics Belgium Biological and medical sciences Diseases of the osteoarticular system Eligibility Eligibility Determination Humans Inflammatory joint diseases Medical sciences Netherlands Perception Practice Guidelines as Topic Practice Patterns, Physicians' - statistics & numerical data Reimbursement criteria Reimbursement Mechanisms Rheumatoid arthritis Severity of Illness Index Treatment Failure Tumor Necrosis Factor-alpha - antagonists & inhibitors United Kingdom Perception Anti-TNF treatment Eligibility Rheumatoid arthritis Reimbursement criteria Human Immunopathology Diseases of the osteoarticular system Rheumatology Anti-TNF Autoimmune disease Inflammatory joint disease Chronic Treatment
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Summary:	Objectives. To assess discrepancies between perception of Belgian rheumatologists on eligibility of RA patients for anti-TNF treatment and Belgian reimbursement criteria and to compare Belgian with Dutch criteria and UK guidelines. Methods. Consecutive MTX-experienced patients with active RA were recruited from 25 private and academic rheumatology practices. Discrepancies between eligibility for anti-TNF treatment according to the rheumatologist and fulfillment of Belgian reimbursement criteria [HAQ ⩾25%, tender joint count (TJC) and swollen joint count (SJC) ⩾8; ⩾1 erosion; failure of ⩾2 DMARDs including MTX; no tuberculosis] were recorded. Reasons for failing the Belgian criteria and results of applying Dutch reimbursement criteria and UK guidelines on the dataset were analysed. Results. Of 492 patients, rheumatologists considered 135 (27.4%) as eligible, whereas Belgian criteria were fulfilled for only 34 (6.9%). Positive predictive value (PPV) of rheumatologists’ perception on eligibility for fulfillment of Belgian criteria was 22.9%, whereas negative predictive value (NPV) was 99.1%. The 104 patients (21.1%) considered eligible despite criteria not being fulfilled had significantly greater TJCs, SJCs, disease activity score (DAS28) and Rheumatoid Arthritis Disease Activity Index scores than the 385 patients (78.2%) in the no-discrepancy group. Number of swollen joints, HAQ and erosions mainly accounted for discrepancies. Of 492 patients, 263 (53.4%) qualified for Dutch criteria and 41 (8.3%) for UK guidelines. PPV of Belgian rheumatologists’ perception was 72.6% for fulfilling Dutch criteria (NPV 49.6%) and 23.4% for UK guidelines (NPV 96.7%). Conclusions. Rheumatologists consider more RA patients eligible for anti-TNF treatment than would be reimbursed according to Belgian criteria. Dutch guidelines, based on DAS28, match more closely eligibility according to Belgian rheumatologists.
Bibliography:	ArticleID:kep018 istex:B1432A79EF0346E1413E1F16D3B0B3C85705DE4D ark:/67375/HXZ-ZPNRGNPK-6 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1462-0324 1462-0332
DOI:	10.1093/rheumatology/kep018