Background/Purpose:

In the treatment of patients with RA, EULAR recommends to initiate biologic DMARDs after failing synthetic DMARDs. However, biologics are costly, and it is not known to what extent limited access to these drugs can hamper implementation of the EULAR recommendations. A poor ability to adhere to these recommendations might contribute to health disparities previously seen in RA patients across countries [1]. The purpose of the study was to explore access to biologics across Europe along the three dimensions of access: availability, affordability and acceptability.

Methods:

Number of reimbursed drugs, prices of biologics, and data on cultural acceptability of biologics were collected by questionnaire sent to one representative rheumatologist in 49 countries of the European Region. To ensure comparability, national prices were converted into international dollars ($) to adjust for the countries’ purchasing power parity (PPP). Data on socio-economic welfare (gross domestic product (GDP), health expenditure, median income and minimum wage) were retrieved from web-based sources. Data on RA health status (DAS28, HAQ, TJC, SJC, ESR) were retrieved from the literature (QUEST RA) [1]. Indicators of access in each axis were correlated with indicators of welfare and RA health status using Spearman correlations.

Results:

In total, 46 countries (response rate 94%) provided data. With respect to availability, in 10 countries no biologics were reimbursed, while 5 or more were reimbursed in 27 countries. With respect to affordability, annual average prices per patient of all available biologics varied from €9,431 (Turkey) to €21,349 (Germany), corresponding to a price ratio of 2.3. However, after adjusting the prices for PPPs, prices ranged from int.$14,446 to int.$61,552 (price ratio 4.3). Cultural acceptability ranged from 0 to 10 (10 poorest acceptability). Number of reimbursed drugs showed moderate to very strong positive correlation with the economic welfare and inverse correlation with the RA health status. While national prices seemed to be slightly lower in low income countries, after adjusting to PPP prices were strongly inversely correlated with economic welfare and positively with RA health. The sum-score of the acceptability was negatively associated with the economic indicators, and positively with the RA health status (table).

	Range	Mean (SD)	Median	Correlations with GDP	Correlations with median income	Correlations with mean DAS28	Correlations with SCJ
Total number of biologics reimbursed	0-8	4.9 (3.3)	7	0.88	0.59	-0.78	-0.61
Average annual price of biologics, int.$	14,446 -61,552	28,548.1 (10,768.5)	27,632.13	-0.84	-0.75	0.75	0.72
Average acceptability score	0-10	5.1 (3.3)	2.5	-0.63	-0.37	0.69	0.71

Conclusion:

European countries with lower socio-economic status seem to have less access to biologics in terms of lower availability, affordability and acceptability (more barriers), while health of RA patients is worse. This implies inequity in access for innovative care disfavoring patients in poorer societies.

References: [1].Sokka T et al. Ann Rheum Dis 2009;68,1666-72

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/inequities-in-access-to-biologic-disease-modifying-anti-rheumatic-drugs-for-patients-with-rheumatoid-arthritis-across-46-european-countries/