title: Inequities in access to biologic and synthetic DMARDs across 46 European countries.
abstract: OBJECTIVE
  We investigated access to biologic and synthetic disease modifying drugs (bDMARDs and sDMARDs) in patients with rheumatoid arthritis (RA) across Europe.
  
  
  METHODS
  A cross-sectional study at national level was performed in 49 European countries. A questionnaire was sent to one expert, addressing the number of approved and reimbursed bDMARDs and sDMARDs, prices and co-payments, as well as acceptability of bDMARDs (barriers). Data on socio-economic welfare (gross domestic product per capita (GDP), health expenditure, income) were retrieved from web-based sources. Data on health status of RA patients were retrieved from an observational study. Dimensions of access (availability, affordability and acceptability) were correlated with the country's welfare and RA health status.
  
  
  RESULTS
  In total, 46 countries (94%) participated. Six countries did not reimburse any of the five sDMARDs surveyed, and in ten countries no bDMARDs were reimbursed. While the price of annual treatment with an average sDMARD was never higher than GPD, the price of one year treatment with a bDMARD exceeded GPD in 26 countries. Perceived barriers for access to bDMARDs were mainly found among financial and administrative restrictions. All dimensions of access were positively correlated with the country's economic welfare (coefficients 0.69 to 0.86 for overall access scores).
  
  
  CONCLUSIONS
  Patients with RA in lower income European countries have less access to bDMARDs and sDMARDs, with particularly striking unaffordability of bDMARDs in some of these countries. When accepting that sDMARDs and bDMARDs are equally needed across countries to treat RA, our data point to inequities in access to pharmacological treatment for RA in Europe.
authors: Department of Health Promotion and Education, Maastricht University, School for Public Health and Primary Care (CAPHRI), , Maastricht, The Netherlands.
authors: Polina
authors: P
authors: Putrik
authors: Sofia
authors: S
authors: Ramiro
authors: Tore K
authors: TK
authors: Kvien
authors: Tuulikki
authors: T
authors: Sokka
authors: Milena
authors: M
authors: Pavlova
authors: Till
authors: T
authors: Uhlig
authors: Annelies
authors: A
authors: Boonen
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology*; D001691:Biological Therapy / Q000191:economics / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D016527:Drug Costs; D005060:Europe / Q000453:epidemiology; D005260:Female; D006304:Health Status; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents
keywords: DMARDs (biologic); DMARDs (synthetic); Health services research; Rheumatoid Arthritis