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Table 5 Reasons for discordance between the effectiveness algorithm and the effectiveness gold standard

From: Derivation and preliminary validation of an administrative claims-based algorithm for the effectiveness of medications for rheumatoid arthritis

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
  1. 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.