Table 5

Reasons for discordance between the effectiveness algorithm and the effectiveness gold standard

Reasons for discordance

Satisfied effectiveness algorithm, did not meet effectiveness gold standard (false-positives)

(n = 19)

Did not satisfy effectiveness algorithm, met effectiveness gold standard (false-negatives)

(n = 23)

Presumed reasons for not meeting gold standard, obtained from medical record review

Biologic change deferred in light of concerns for new/worsened comorbidity

10

-

Clinically stable or improved and patient/physician satisfied, but DAS and DAS change did not meet gold standard effectiveness criteria

4

-

Physician recognized inadequate response, but chose to retreat with rituximab only after 1 year

2

Receiving some medications (for example, glucocorticoids) outside of the VHA system

1

-

Biologic change deferred in light of surgery or procedure

1

-

Physician recommended biologic change or dose change, but patient declined

1

-

Noncompliance with nonbiologic RA medications

1

-

Components of the effectiveness algorithm that were not met despite having met the effectiveness gold standard

Glucocorticoid dose increase or initiation

-

15

Added new DMARD(s)

-

6

Increase in biologic dose and/or frequency

-

2

VHA: Veterans Health Administration; RA: rheumatoid arthritis; DMARD: disease-modifying. Data shown are the number of treatment episodes in the off-diagonal cells given in Table 4. Column totals may sum to > 100% because there may be multiple reasons why patients did not meet the effectiveness gold standard or the effectiveness algorithm. -, criterion is not applicable.

Curtis et al. Arthritis Research & Therapy 2011 13:R155   doi:10.1186/ar3471