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
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2014년 1월부터 류마티스 관절염 환자의 TNF-α 억제제 사용에 관한 급여기준이 기존의 다양한 검사 결과를 요구하는 방법에서 DAS28이라는 지표를 활용하는 방향으로 완화되었다. 본 연구에서는 이 급여기준의 변경 전후 1년간 류마티스 관절염(한국표준질병사인분류 M05, M06) 노인 환자들의 TNF-α 억제제 이용 변화를 분석비교하였다. 건강보험심사평가원의 2013, 2014년 고령환자데이터셋을 활용하여 분석하였고, 구간별 회귀분석을 이용한 개입 시계열 분석방법을 적용하여 급여기준의 변경 전후 1년간 월별 TNF-α 억제제의 처방건과 사용량을 분석하였다. 사용량은 천명의 류마티스 관절염 환자의 일당 정립 용량(Daily Defined Dose)를 사용하였다. 분석결과, 급여기준 변경 후 월별 TNF-α 억제제의 처방건과 사용량은 유의한 변화를 보이지 않았다. 그러나 의료기관 종별에 따라 하위분석을 실시한 결과, 급여기준 변경 후 상급종합병원에서의 월별 처방과 사용량은 증가하였고, 종합병원, 병원/의원에서의 월별 처방과 사용량은 감소한 것으로 나타났다. 전체적으로 급여기준의 변경이 TNF-α 억제제의 처방과 사용에 영향을 미치지 않은 것으로 나타났으나 의료기관 종별에 따라 유의한 변화가 있었다. 급여기준의 개선으로 인해 장기간으로 보았을 때 류마티스 관절염 환자들의 TNF-α 억제제에 대한 접근성이 증가했는지에 대한 추가적인 연구가 필요할 것으로 보인다.
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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