Access to RA Medications Varies Across Europe

Kate Johnson

June 06, 2012

June 6, 2012 (Berlin, Germany) — There is significant variation in access to reimbursed biologic therapy for rheumatoid arthritis across Europe, resulting in inequality and inconsistent care, researchers reported here at the European League Against Rheumatism Congress 2012.

Numerous clinical recommendations point to the use of biologic disease-modifying antirheumatic drugs (DMARDs) when targeting the treatment of rheumatoid arthritis to below 2.6 on the Disease Activity Score of 28 joints (DAS28), said PhD student Polina Putrik, from the Department of Health Promotion and Education, Maastricht University in the Netherlands, during a press conference.

However, the results of a new study show that many countries do not follow evidence-based guidelines for this therapy, with almost one quarter of countries providing no access to biologics, said Putrik.

Countries with the lowest socioeconomic status had the most restricted access to biologics and the highest prices; the price in the Ukraine and Russia is 4-fold higher than that in Belgium and Great Britain.

"Our findings, we hope...will alert some stakeholders to strive for more homogenous access to these treatments," she said.

The researchers surveyed 1 representative rheumatologist from each of 46 European countries and compared clinical eligibility criteria for the start of a first reimbursed biologic. Eight biologics were included in the investigation: infliximab, etanercept, adalimumab, certolizumab pegol, golimumab, abatacept, tocilizumab, and rituximab.

An email questionnaire was used to ask rheumatologists whether reimbursement issues or clinical recommendations were the main influence regulating their prescription of biologics in clinical practice.

Additional information on eligibility criteria for biologics was collected, including required disease duration, disease activity, disease severity, and number of previous DMARDs.

Using this information, the investigators scored the level of restriction in access to reimbursed biologics on a scale of 0 (more restricted) to 5 (easier access).

The survey revealed that among the 46 countries, 10 provided no reimbursement for biologic therapy.

Among the remaining 36 countries, reimbursement criteria were the driving force behind eligibility in 13 countries (36%), whereas clinical recommendations drove prescribing in 7 countries (19%). A combination of both factors (usually because they were similar) was identified in 15 countries (42%), whereas 10 countries (22%) had no regulation of access to reimbursed biologics.

Among the countries in which at least 1 biologic was reimbursed, 20 (56%) had no disease duration criteria to initiate a biologic; in the remaining countries, a disease duration of 3 to 12 months was mandatory.

Most countries (47%) required a patient to have failed therapy with 2 synthetic DMARDs before qualifying for biologic therapy, 42% required the failure of 1 or none, and 11% required the failure of more than 2.

Among the 36 countries, 30 specified that a minimum level of disease activity be reached before treatment with biologics; 11 countries required a DAS28 of 3.2 or less and the remainder required a higher DAS28.

Three countries (8%) had the most liberal eligibility DAS28 (5.0), whereas 19% had a DAS28 of 4.0, 22% had a DAS28 score of 3.0, 17% had a DAS28 of 2.0, 28% had a DAS28 score of 1, and 6% (2 countries) had the most restrictive DAS28 (0.0).

Countries from Eastern Europe and the former Soviet Union were more likely to have more restrictive scores.

Dr. Putrik has disclosed no relevant financial relationships.

European League Against Rheumatism (EULAR) Congress 2012: Abstract OP0011. Presented June 6, 2012.

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