title: Analysis of 4-year Dutch reimbursement application data of biological therapies for psoriatic arthritis.
abstract: OBJECTIVE
  To get the approval for reimbursement of biological therapies for PsA, patients need to fulfil specific criteria in many countries. The aim of this study was to evaluate the 4-year Dutch reimbursement application data, including the diagnostic, disease activity and response criteria that were applied for treatment of PsA with biologics.
  
  
  METHODS
  All initial and follow-up applications for approval of treatment with biologics were included for investigation. Data were analysed descriptively with regard to application characteristics, patient characteristics and response to therapy.
  
  
  RESULTS
  In the period studied, 3723 application forms of 1991 patients were received. This concerned 2118 initial treatment applications and 1605 follow-up applications. Of all initial treatment applications, 2003 (94.6%) were approved. The major part of all applications concerned requests for etanercept (59.1%), followed by adalimumab (38.2%). Patients were suffering from polyarthritis in most cases (63.1%). MTX was used by nearly all patients, but only 55.8% had used the required dosage of 25 mg/week. Approximately 79.4% of all patients met the response criteria after 3 months of treatment. The mean number of affected joints declined from 7.7 at first application to 1.4 at follow-up. The initial visual analogue scale (VAS) score indicated by patients decreased from 71.2 to 24.1 at follow-up. The VAS score indicated by physicians decreased from 66.0 to 18.4.
  
  
  CONCLUSIONS
  Biologics are expensive, but highly effective in the treatment of PsA. Careful compilation of treatment and reimbursement criteria is important for patients as well as for physicians and health insurance companies.
authors.affiliation: Department of Dermatology, Radboud University Nijmegen Medical Centre, GL Nijmegen, The Netherlands. r.driessen@derma.umcn.nl
authors.forename: Rieke J B
authors.initials: RJ
authors.lastname: Driessen
authors.forename: Elke M G J
authors.initials: EM
authors.lastname: de Jong
authors.forename: Gerrit W
authors.initials: GW
authors.lastname: Salemink
authors.forename: Jan H G
authors.initials: JH
authors.lastname: Bürer
authors.forename: Peter C M
authors.initials: PC
authors.lastname: van de Kerkhof
authors.forename: Frank H J
authors.initials: FH
authors.lastname: van den Hoogen
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use*; D015535:Arthritis, Psoriatic / Q000188:drug therapy* / Q000191:economics; D001688:Biological Products / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D004363:Drug Utilization / Q000706:statistics & numerical data; D000068800:Etanercept; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007074:Immunoglobulin G / Q000191:economics / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009426:Netherlands; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012051:Reimbursement Mechanisms / Q000706:statistics & numerical data; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D001688:Biological Products; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068879:Adalimumab; D000068800:Etanercept; D008727:Methotrexate