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.