습성 나이관련황반변성에서 산정특례 재등록이 불가한 환자의 비율과 원인
Proportion and Reasons for Ineligibility to Re-register for Extended Health Insurance in Neovascular Age-related Macular Degeneration
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목적: 습성 나이관련황반변성으로 산정특례에 최초 등록된 환자들 중 5년 경과 시점에 재등록이 불가한 환자들의 비율과 원인을 확인하고자 한다. 대상과 방법: 본 후향적 연구는 습성 나이관련황반변성으로 최초 진단되어 중증 난치성 질환 산정특례를 신청한 후 5년 이상 경과 관찰한 환자를 대상으로 시행되었다. 산정특례 등록 후 5년 시점에 재등록 기준 충족 여부를 확인하였으며, 재등록 기준을 충족시키지 못하는 이유를 추가적으로 분석하였다. 결과: 총 263명을 대상으로 결과를 분석하였으며, 재등록 기준을 만족시키지 못한 경우는 148명(56.3%)이었다. 재등록 신청일로부터 6개월 이내에 직접적인 치료를 시행하지 않은 경우는 98명(재발이 없어 추가 주사 없이 경과 관찰 51명, 원반반흔을 동반하지는 않으나 망막이 손상되어 추가 치료가 효과 없을 것으로 판단된 상태 44명)이었으며, 원반반흔의 발생이 확인된 경우는 50명이었다. 고령(p=0.013)과 시력이 나쁜 경우(p=0.004), 그리고 망막혈관종증식(p<0.001)에서 심한 망막 손상으로 산정특례 재등록을 하지 못하는 경우가 많았다. 결론: 최초 산정특례를 등록한 전체 환자의 56.3%에서 재등록 기준을 만족시키지 못하였는데, 가장 주된 이유는 망막의 손상이 진행한 경우였다. 본 연구의 결과는 환자 설명 및 장기적인 치료 방침 설정에 유용한 정보를 제공해 줄 수 있을 것으로 생각된다.
Abstract
Purpose: To evaluate the proportion and reasons for ineligibility to re-register for extended health insurance at 5 years in patients diagnosed with neovascular age-related macular degeneration (AMD) and registered for extended health insurance. Methods: This retrospective study was performed in patients diagnosed with neovascular AMD and registered for extended health insurance with follow-up for at least 5 years. The criteria for re-registration for extended health insurance were determined along with the ineligibility for re-registration. Results: In total, 263 patients were included in the analysis. Of these, 148 (56.3%) did not satisfy the criteria for re-registration. No active treatment was performed in 98 patients during the last 6 months of the study period (no recurrence, 51 patients; additional treatment was not considered beneficial due to retinal damage even without disciform scar formation, 44 patients). Macular disciform scar formation was noted in 50 patients (33.8%). Older age (p = 0.013), poor visual acuity (p = 0.004), and retinal angiomatous proliferation (p < 0.001) were associated with ineligibility for re-registration due to severe retinal damage. Conclusions: Among the patients who were initially registered for extended health insurance, 56.3% failed to satisfy the re-registration criteria. The primary reason was advanced retinal damage. The results of this study provide useful information for patient education and to establish long-term treatment strategies.
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