title: Patients' access to biologics in rheumatoid arthritis: a comparison between Portugal and other European countries.
abstract: BACKGROUND
  Despite the widespread availability of biologics across Europe, rheumatoid arthritis (RA) patients' access to these drugs differs significantly among countries.
  
  
  OBJECTIVE
  To compare the proportion of RA patients treated with biologics across Europe and investigate the factors that most influence it, with focus on the Portuguese case, reportedly with low access rates to biologics.
  
  
  METHODS
  The biologics' market was characterized for 15 selected European countries. Variables potentially influencing patients' access to biologics (PAB) in RA were also collected, including demographic, disease, economic, funding and biologics' market-related data. A multivariable regression model identified the factors that best explain PAB. Based on these determinants, a cluster analysis was performed to group the countries with most similar behaviour regarding PAB allowing the evaluation of Portugal's relative position among these countries.
  
  
  RESULTS
  The regression model (R(2) = 0.953) indicated that PAB in selected countries is explained mostly by its gross domestic product (GDP) per capita, the usage of methotrexate (MTX) and the biologics' distribution channel. Current MTX usage in Portugal shows similarity with practice from UK, France, Germany or Spain 5 years before, explaining why PAB in Portugal stood at 7% in 2010, 12 percentage points below the average of selected countries.
  
  
  CONCLUSIONS
  Variations in RA PAB were found across selected countries with Portugal showing the lowest proportion. GDP per capita, biologics distribution channel and consumption of MTX appear to be the best explanatory factors for these fluctuations in European countries.
authors.affiliation: Outcomes Research, Merck Sharp & Dohme, Edificio Vasco da Gama, nº 19 , 2770-192, Paço de Arcos, Portugal, pedro.laires@merck.com.
authors.forename: P A
authors.initials: PA
authors.lastname: Laires
authors.forename: F
authors.initials: F
authors.lastname: Exposto
authors.forename: R
authors.initials: R
authors.lastname: Mesquita
authors.forename: A P
authors.initials: AP
authors.lastname: Martins
authors.forename: L
authors.initials: L
authors.lastname: Cunha-Miranda
authors.forename: J E
authors.initials: JE
authors.lastname: Fonseca
mesh_terms: D018501:Antirheumatic Agents / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics*; D001688:Biological Products / Q000191:economics / Q000600:supply & distribution / Q000627:therapeutic use*; D005060:Europe; D005102:Health Expenditures; D006297:Health Services Accessibility / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D011174:Portugal; D012959:Socioeconomic Factors
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products; D008727:Methotrexate