Guideline-Orientated Prescription of Disease-Modifying Drugs in Patients with Rheumatoid Arthritis - an Analysis Based on Social Health Insurance Claims Data

Background With the market entry of biologics, the treatment of rheumatoid arthritis (RA) has changed fundamentally in terms of efficacy and costs. The aim of this study is to analyse the treatment according the guideline of the German society of rheumatology for RA patients with disease-modifying anti-rheumatic drugs (DMARDs) using claims data from the statutory health insurance. Materials and methods The claims data of the Techniker Krankenkasse were analysed retrospectively for the years 2011 - 2014. Subgroup analyses were used to conduct prescription and treatment differences with respect to guideline-recommended conventional DMARDs and biologics. Results The study population included 55,538 RA patients (29.7 % incidence, 70.3 % prevalence, 22.3 % M05: Seropositive rheumatoid arthritis, 77.7 % M06: Other rheumatoid arthritis). Only 21,616 insured patients (38.9 %) were prescribed a guideline-recommended conventional DMARD or biologic at least once within one year of/after the first diagnosis. Among incident patients, the coverage rate with disease-modifying drugs was below the prevalence patients (31.5 % vs. 42.1 %). 60.9 % of M05 patients and only 29.7 % of M06 patients received a single DMARD after index diagnosis. If a DMARD has been prescribed, then it was prescribed, on average, within the first quarter of the initial diagnosis. The leading role in the prescription of basic therapies for index medication is provided by the rheumatologist. Nevertheless, 68.3 % of patients consulted a specialist in rheumatology at least once within a year of the first diagnosis. Conclusion The results of this large sample show differences in the guideline recommended prescription of disease-modifying drugs for different subgroups of RA as well as an under-supply in patients not treated by the rheumatologist.