title: Biological therapy in inflammatory bowel diseases: access in Central and Eastern Europe.
abstract: Biological drugs opened up new horizons in the management of inflammatory bowel diseases (IBD). This study focuses on access to biological therapy in IBD patients across 9 selected Central and Eastern European (CEE) countries, namely Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania and Slovakia. Literature data on the epidemiology and disease burden of IBD in CEE countries was systematically reviewed. Moreover, we provide an estimation on prevalence of IBD as well as biological treatment rates. In all countries with the exception of Romania, lower biological treatment rates were observed in ulcerative colitis (UC) compared to Crohn's disease despite the higher prevalence of UC. Great heterogeneity (up to 96-fold) was found in access to biologicals across the CEE countries. Poland, Bulgaria, Romania and the Baltic States are lagging behind Hungary, Slovakia and the Czech Republic in their access to biologicals. Variations of reimbursement policy may be one of the factors explaining the differences to a certain extent in Bulgaria, Latvia, Lithuania, and Poland, but association with other possible determinants (differences in prevalence and incidence, price of biologicals, total expenditure on health, geographical access, and cost-effectiveness results) was not proven. We assume, nevertheless, that health deterioration linked to IBD might be valued differently against other systemic inflammatory conditions in distinct countries and which may contribute to the immense diversity in the utilization of biological drugs for IBD. In conclusion, access to biologicals varies widely among CEE countries and this difference cannot be explained by epidemiological factors, drug prices or total health expenditure. Changes in reimbursement policy could contribute to better access to biologicals in some countries.
authors: Fanni Rencz, Márta Péntek, László Gulácsi, Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary.
authors: Fanni
authors: F
authors: Rencz
authors: Fanni Rencz, Márta Péntek, László Gulácsi, Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary.
authors: Márta
authors: M
authors: Péntek
authors: Fanni Rencz, Márta Péntek, László Gulácsi, Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary.
authors: Martin
authors: M
authors: Bortlik
authors: Fanni Rencz, Márta Péntek, László Gulácsi, Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary.
authors: Edyta
authors: E
authors: Zagorowicz
authors: Fanni Rencz, Márta Péntek, László Gulácsi, Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary.
authors: Tibor
authors: T
authors: Hlavaty
authors: Fanni Rencz, Márta Péntek, László Gulácsi, Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary.
authors: Andrzej
authors: A
authors: Śliwczyński
authors: Fanni Rencz, Márta Péntek, László Gulácsi, Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary.
authors: Mihai M
authors: MM
authors: Diculescu
authors: Fanni Rencz, Márta Péntek, László Gulácsi, Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary.
authors: Limas
authors: L
authors: Kupcinskas
authors: Fanni Rencz, Márta Péntek, László Gulácsi, Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary.
authors: Krisztina B
authors: KB
authors: Gecse
authors: Fanni Rencz, Márta Péntek, László Gulácsi, Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary.
authors: László
authors: L
authors: Gulácsi
authors: Fanni Rencz, Márta Péntek, László Gulácsi, Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary.
authors: Peter L
authors: PL
authors: Lakatos
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D001688:Biological Products / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000276:immunology; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology / Q000276:immunology; D016527:Drug Costs; D005061:Europe, Eastern / Q000453:epidemiology; D006297:Health Services Accessibility / Q000639:trends; D054625:Healthcare Disparities / Q000639:trends; D006801:Humans; D007349:Insurance, Health, Reimbursement; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000639:trends*; D015995:Prevalence; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D001688:Biological Products
keywords: Access; Biological therapy; Crohn’s disease; Europe, Central and Eastern; Inflammatory bowel diseases; Ulcerative colitis