title: Access to biologic treatment for rheumatoid arthritis in Central and Eastern European (CEE) countries.
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.
  
  
  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.
authors: Center for Pharmacoeconomics, Warsaw, Poland. ewaorlewska@go2.pl
authors: Ewa
authors: E
authors: Orlewska
authors: Ioan
authors: I
authors: Ancuta
authors: Branimir
authors: B
authors: Anic
authors: Catalin
authors: C
authors: Codrenau
authors: Nemanja
authors: N
authors: Damjanov
authors: Predrag
authors: P
authors: Djukic
authors: Ruxandra
authors: R
authors: Ionescu
authors: Lubomir
authors: L
authors: Marinchev
authors: Evgeny L
authors: EL
authors: Nasonov
authors: Tonu
authors: T
authors: Peets
authors: Sonja
authors: S
authors: Praprotnik
authors: Rasho
authors: R
authors: Rashkov
authors: Jana
authors: J
authors: Skoupa
authors: Witold
authors: W
authors: Tlustochowicz
authors: Malgorzata
authors: M
authors: Tlustochowicz
authors: Matija
authors: M
authors: Tomsic
authors: Tiina
authors: T
authors: Veldi
authors: Jelena
authors: J
authors: Vojinovic
authors: Piotr
authors: P
authors: Wiland
mesh_terms: D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology / Q000628:therapy*; D001691:Biological Therapy; D003365:Costs and Cost Analysis; D003695:Delivery of Health Care / Q000191:economics; D005060:Europe; D005102:Health Expenditures; D006287:Health Planning Guidelines; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans
chemical_list: D018501:Antirheumatic Agents