Disparities in the organisation of national healthcare systems for treatment of patients with psoriatic arthritis and axial spondyloarthritis across Europe.
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Michelsen Brigitte, Østergaard Mikkel, Nissen Michael John, Ciurea Adrian, Möller Burkhard, Midtbøll Ørnbjerg Lykke, Horák Pavel, Glintborg Bente, MacDonald Alan, Laas Karin, Sokka-Isler Tuulikki, Gudbjornsson Bjorn, Iannone Florenzo, Hellamand Pasoon, Kvien Tore Kristian, Rodrigues Ana Maria, Codreanu Catalin, Rotar Ziga, Castrejón Isabel, Wallman Johan Karlsson, Pavelka Karel, Loft Anne Gitte, Heddle Maureen, Vorobjov Sigrid, Relas Heikki, Gröndal Gerdur, Gremese Elisa, van der Horst-Bruinsma Irene, Kristianslund Eirik Klami, Santos Maria José, Mogosan Corina, Tomsic Matija, Diaz-Gonzalez Federico, Giuseppe Daniela Di, Nielsen Stig Winther, Hetland Merete Lund
Аннотация
OBJECTIVES: To map and compare national healthcare set-ups for prescription, start, switch, tapering, and discontinuation of biologic/targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with psoriatic arthritis and axial spondyloarthritis across Europe, and assess the healthcare set-ups in relation to countries' socio-economic status.
METHODS: An electronic survey was developed to collect and compare information on national healthcare systems. The relationship between the cumulative score of biologic/targeted synthetic DMARD regulations, socioeconomic indices, and biologic originator costs were assessed by linear regression.
RESULTS: National healthcare set-ups differed considerably across the 15 countries, with significantly fewer regulations with increasing socioeconomic status measured by GDP/current health expenditure/human development index, and with increasing biologic originator costs. In most countries, the biologic/targeted synthetic DMARD prescribing doctor was required to adhere to country and/or hospital recommendations, and about a third of countries had a national/regional tender process. Prescription regulations for biologic/targeted synthetic DMARDs, including pre-treatment and disease activity requirements, varied substantially. Approximately a third of countries had criteria for discontinuation and tapering, whereas only few had for switching. Notably, two countries disallowed biologic/targeted synthetic DMARD retrials, and one imposed limit on the maximum number of biologic/targeted synthetic DMARDs permitted.
CONCLUSION: The findings highlight substantial variability in healthcare set-ups for biologic/targeted synthetic DMARD use in psoriatic arthritis and axial spondyloarthritis across Europe and their association with socioeconomic status and drug costs. These insights provide a basis for rheumatology societies, policymakers, and stakeholders to evaluate and potentially optimize healthcare policies.