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
Department of Rheumatology, University Hospitals Leuven, Leuven, Belgium.
Rheumatology (Oxford). 2009 May;48(5):546-50. doi: 10.1093/rheumatology/kep018. Epub 2009 Mar 1.
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.
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 > or =25%, tender joint count (TJC) and swollen joint count (SJC) > or =8; > or =1 erosion; failure of > or =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.
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%).
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.
评估比利时风湿病专家对类风湿关节炎（RA）患者抗TNF治疗资格的认知与比利时报销标准之间的差异，并将比利时标准与荷兰标准及英国指南进行比较。
从25家私立和学术性风湿病诊疗机构招募连续的、使用甲氨蝶呤（MTX）且病情活跃的RA患者。记录风湿病专家认为的抗TNF治疗资格与比利时报销标准（健康评估问卷[HAQ]≥25%、压痛关节计数[TJC]和肿胀关节计数[SJC]≥8；≥1处侵蚀；≥2种包括MTX在内的改善病情抗风湿药治疗失败；无结核病）的满足情况之间的差异。分析未满足比利时标准的原因以及将荷兰报销标准和英国指南应用于该数据集的结果。
在492例患者中，风湿病专家认为135例（27.4%）符合资格，而仅34例（6.9%）满足比利时标准。风湿病专家对符合比利时标准资格认知的阳性预测值（PPV）为22.9%，而阴性预测值（NPV）为99.1%。尽管不符合标准但仍被认为符合资格的104例患者（21.1%）的TJC、SJC、疾病活动评分（DAS28）和类风湿关节炎疾病活动指数评分显著高于无差异组中的385例患者（78.2%）。肿胀关节数、HAQ和侵蚀主要导致了差异。在492例患者中，263例（53.4%）符合荷兰标准，41例（8.3%）符合英国指南。比利时风湿病专家认知的PPV对于满足荷兰标准为72.6%（NPV为49.6%），对于英国指南为23.4%（NPV为96.7%）。
与根据比利时标准可报销的情况相比，风湿病专家认为有更多RA患者符合抗TNF治疗资格。基于DAS28的荷兰指南与比利时风湿病专家认定的资格更接近。
