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Access to biologic treatment for rheumatoid arthritis in Central and Eastern European (CEE) countries.

Orlewska E, Ancuta I, Anic B, Codrenau C, Damjanov N, Djukic P, Ionescu R, Marinchev L, Nasonov EL, Peets T, Praprotnik S, Rashkov R, Skoupa J, Tlustochowicz W, Tlustochowicz M, Tomsic M, Veldi T, Vojinovic J, Wiland P - Med. Sci. Monit. (2011)

Bottom Line: Affordability index for biologic drugs was the lowest in Slovenia (0.4).In each country national guidelines define which patients are eligible for biologic treatment.Disease Activity Score (DAS28) of over 5.1 and failure of 2 or more disease-modifying anti-RA drugs, including methotrexate, are commonly used criteria.

View Article: PubMed Central - PubMed

Affiliation: Center for Pharmacoeconomics, Warsaw, Poland. ewaorlewska@go2.pl

ABSTRACT

Background: The aim of this study was to assess and compare patients' access to biologic anti-RA drugs in selected Central and Eastern European (CEE) countries and to analyze the determinants of differences between countries.

Material/methods: This is a multi-country survey study, based on a combination of desk research and direct contact with national RA stakeholders. Data was collected using a pre-defined questionnaire. Affordability was measured using an affordability index, calculated comparing the index of health care expenditures to the price index, using Poland as an index of 1.

Results: The percentage of patients on biologic treatment in 2009 was highest in Hungary (5% RA patients on biologic treatment), followed by Slovenia (4.5%), Slovakia (3.5%), Czech Republic (2.92%), Romania (2.2%), Estonia (1.8%), and Croatia, Serbia, Poland (below 1.5%). Infliximab, etanercept, adalimumab and rituximab were included in the reimbursement system in all countries, but abatacept and tocilizumab were included only in Slovakia. In Slovenia, public payer covered 75% of the price, and 25% is covered by supplementary health insurance; in Bulgaria public payer covered 50% of etanercept and adalimumab costs, and 75% of rituximab cost. In other countries, biologic drugs are reimbursed at 100%. Affordability index for biologic drugs was the lowest in Slovenia (0.4). In each country national guidelines define which patients are eligible for biologic treatment. Disease Activity Score (DAS28) of over 5.1 and failure of 2 or more disease-modifying anti-RA drugs, including methotrexate, are commonly used criteria.

Conclusions: The most important factors limiting access to biologic anti-RA treatment in the CEE region are macroeconomic conditions and restrictive treatment guidelines.

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Percentage of RA patients on biologic treatment.
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f3-medscimonit-17-4-sr1: Percentage of RA patients on biologic treatment.

Mentions: In order to describe access to RA biologic treatments, the information on the number of patients actually treated in each country, as well as on the proportion of RA patients those represent, was required. However, such data are not readily available. Information on absolute numbers of patients receiving biologic treatment has been derived from registries or insurance fund databases in 9 countries (Czech Republic, Croatia, Estonia, Hungary, Poland, Serbia, Slovakia, Romania and Slovenia). In 2009 the highest number of RA patients who have received at least 1 dose of treatment with biologic drugs was in Hungary (2,048 patients), followed by Romania (1,800 patients), Poland (1,443) and Czech Republic (1,200). As the absolute number of patients does not provide any comparison due to the fact that populations and prevalence differ between countries, we calculated the proportion of patients on treatment, based on country-specific epidemiological indicators (adult population and RA prevalence rate). Results of this comparison show that in 2009 the clear front-runner was Hungary (5% of RA patients on biologic treatment), followed by Slovenia (4.5%), Slovakia (3.5%), and the Czech Republic (2.92%). In Romania and Estonia the average usage was around 2% (2.2% and 1.8%, respectively), and in Croatia, Serbia and Poland it was below 1.5% (1.4%, 1.3 and 1%, respectively) (Figure 3). An analysis of drug use revealed further differences among countries, which reflects national preferences and priorities. Croatia appears to have a clear preference for infliximab over etanercept and adalimumab, while Hungary, Czech Republic, Slovakia and Slovenia seem to give priority to etanercept and adalimumab over infliximab. In Poland, similar proportions of patients are treated with etanercept (38%) and infliximab (34%), while adalimumab is used in only 8% of patients. In Serbia, only 1 TNF-inhibitor, etanercept, is used. Differences between etanercept and infliximab use may reflect preferences for hospital products in those countries, or may be the consequence of restricted indications. For example, in Poland treatment must be initiated with infliximab, which is the least expensive drug, while in Slovenia infliximab is indicated only as the second-line treatment. There are also specific barriers to prescribing IV biologic anti-RA drugs in Slovenia: hospital drugs are reimbursed only for a limited number of patients (fixed budget for a given year). The relatively low use of adalimumab in Poland can be explained by the fact that adalimumab is indicated as a second-line anti-TNF treatment only. In Slovakia, adalimumab is used as a first-line treatment, and in other countries as both first- or second-line treatment. Rituximab is indicated as a treatment option after failure of TNF-inhibitor therapy in all countries except Russia. The proportion of patients treated with rituximab is the highest in Slovakia, Serbia and Poland.


Access to biologic treatment for rheumatoid arthritis in Central and Eastern European (CEE) countries.

Orlewska E, Ancuta I, Anic B, Codrenau C, Damjanov N, Djukic P, Ionescu R, Marinchev L, Nasonov EL, Peets T, Praprotnik S, Rashkov R, Skoupa J, Tlustochowicz W, Tlustochowicz M, Tomsic M, Veldi T, Vojinovic J, Wiland P - Med. Sci. Monit. (2011)

Percentage of RA patients on biologic treatment.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3539513&req=5

f3-medscimonit-17-4-sr1: Percentage of RA patients on biologic treatment.
Mentions: In order to describe access to RA biologic treatments, the information on the number of patients actually treated in each country, as well as on the proportion of RA patients those represent, was required. However, such data are not readily available. Information on absolute numbers of patients receiving biologic treatment has been derived from registries or insurance fund databases in 9 countries (Czech Republic, Croatia, Estonia, Hungary, Poland, Serbia, Slovakia, Romania and Slovenia). In 2009 the highest number of RA patients who have received at least 1 dose of treatment with biologic drugs was in Hungary (2,048 patients), followed by Romania (1,800 patients), Poland (1,443) and Czech Republic (1,200). As the absolute number of patients does not provide any comparison due to the fact that populations and prevalence differ between countries, we calculated the proportion of patients on treatment, based on country-specific epidemiological indicators (adult population and RA prevalence rate). Results of this comparison show that in 2009 the clear front-runner was Hungary (5% of RA patients on biologic treatment), followed by Slovenia (4.5%), Slovakia (3.5%), and the Czech Republic (2.92%). In Romania and Estonia the average usage was around 2% (2.2% and 1.8%, respectively), and in Croatia, Serbia and Poland it was below 1.5% (1.4%, 1.3 and 1%, respectively) (Figure 3). An analysis of drug use revealed further differences among countries, which reflects national preferences and priorities. Croatia appears to have a clear preference for infliximab over etanercept and adalimumab, while Hungary, Czech Republic, Slovakia and Slovenia seem to give priority to etanercept and adalimumab over infliximab. In Poland, similar proportions of patients are treated with etanercept (38%) and infliximab (34%), while adalimumab is used in only 8% of patients. In Serbia, only 1 TNF-inhibitor, etanercept, is used. Differences between etanercept and infliximab use may reflect preferences for hospital products in those countries, or may be the consequence of restricted indications. For example, in Poland treatment must be initiated with infliximab, which is the least expensive drug, while in Slovenia infliximab is indicated only as the second-line treatment. There are also specific barriers to prescribing IV biologic anti-RA drugs in Slovenia: hospital drugs are reimbursed only for a limited number of patients (fixed budget for a given year). The relatively low use of adalimumab in Poland can be explained by the fact that adalimumab is indicated as a second-line anti-TNF treatment only. In Slovakia, adalimumab is used as a first-line treatment, and in other countries as both first- or second-line treatment. Rituximab is indicated as a treatment option after failure of TNF-inhibitor therapy in all countries except Russia. The proportion of patients treated with rituximab is the highest in Slovakia, Serbia and Poland.

Bottom Line: Affordability index for biologic drugs was the lowest in Slovenia (0.4).In each country national guidelines define which patients are eligible for biologic treatment.Disease Activity Score (DAS28) of over 5.1 and failure of 2 or more disease-modifying anti-RA drugs, including methotrexate, are commonly used criteria.

View Article: PubMed Central - PubMed

Affiliation: Center for Pharmacoeconomics, Warsaw, Poland. ewaorlewska@go2.pl

ABSTRACT

Background: The aim of this study was to assess and compare patients' access to biologic anti-RA drugs in selected Central and Eastern European (CEE) countries and to analyze the determinants of differences between countries.

Material/methods: This is a multi-country survey study, based on a combination of desk research and direct contact with national RA stakeholders. Data was collected using a pre-defined questionnaire. Affordability was measured using an affordability index, calculated comparing the index of health care expenditures to the price index, using Poland as an index of 1.

Results: The percentage of patients on biologic treatment in 2009 was highest in Hungary (5% RA patients on biologic treatment), followed by Slovenia (4.5%), Slovakia (3.5%), Czech Republic (2.92%), Romania (2.2%), Estonia (1.8%), and Croatia, Serbia, Poland (below 1.5%). Infliximab, etanercept, adalimumab and rituximab were included in the reimbursement system in all countries, but abatacept and tocilizumab were included only in Slovakia. In Slovenia, public payer covered 75% of the price, and 25% is covered by supplementary health insurance; in Bulgaria public payer covered 50% of etanercept and adalimumab costs, and 75% of rituximab cost. In other countries, biologic drugs are reimbursed at 100%. Affordability index for biologic drugs was the lowest in Slovenia (0.4). In each country national guidelines define which patients are eligible for biologic treatment. Disease Activity Score (DAS28) of over 5.1 and failure of 2 or more disease-modifying anti-RA drugs, including methotrexate, are commonly used criteria.

Conclusions: The most important factors limiting access to biologic anti-RA treatment in the CEE region are macroeconomic conditions and restrictive treatment guidelines.

Show MeSH
Related in: MedlinePlus