title: Use of biologics for psoriasis in Central and Eastern European countries.
abstract: OBJECTIVE
  To evaluate the use of biological agents for the treatment of psoriasis and to explore country-specific differences within six Central and Eastern European (CEE) countries, namely Bulgaria, Croatia, the Czech Republic, Hungary, Poland and Romania.
  
  
  METHODS
  A literature overview on the epidemiology and disease burden of psoriasis in CEE was conducted. The number of patients treated with biologics was obtained from patient registries, ministries of health, national professional societies and health insurance funds. Biological treatment rates were estimated by two different methods: (i) as a proportion of all psoriasis patients of a country (assuming a common prevalence of psoriasis 2%) and (ii) per 100,000 population. Moreover, we provide a detailed comparison of drug coverage policies and guidelines regulating the treatment with biologics in psoriasis.
  
  
  RESULTS
  On average 0.25% of all psoriasis patients, or five psoriasis patients out of 100,000 inhabitants are treated with biologics embedding a 14.6-fold difference between the six countries. Bulgaria, Croatia and Poland lag behind the other three countries in the use of biologics. The significant differences among CEE countries cannot be explained by variations in prices of biologics, cost-effectiveness or budget impact of biologics. It seems that the time since coverage decision, the fewer number of covered biologics, the more restrictive criteria to be eligible for covered treatment in terms of baseline Psoriasis Area and Severity Index and Dermatology Life Quality Index scores, and the maximum duration of treatment allowed are responsible for the majority of the differences.
  
  
  CONCLUSIONS
  There exists a disconnect between the European psoriasis treatment guidelines and the various CEE country-specific biologic coverage eligibilities. The cost of biologic therapy for psoriasis is not solely and directly responsible for the different use rates amongst the CEE countries. Psoriasis may not be perceived by all payers as a serious disease that can be successfully treated in a cost-effective manner.
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.|Semmelweis University Doctoral School of Clinical Medicine, Budapest, Hungary.
authors.forename: F
authors.initials: F
authors.lastname: Rencz
authors.affiliation: Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary.
authors.forename: L
authors.initials: L
authors.lastname: Kemény
authors.affiliation: National Health Insurance Fund Administration of Hungary, Budapest, Hungary.
authors.forename: J Z
authors.initials: JZ
authors.lastname: Gajdácsi
authors.affiliation: Department of Dermatology, Military Institute of Medicine, Warsaw, Poland.
authors.forename: W
authors.initials: W
authors.lastname: Owczarek
authors.affiliation: Department of Dermatology, Charles University 3rd Medical Faculty, Prague, Czech Republic.
authors.forename: P
authors.initials: P
authors.lastname: Arenberger
authors.affiliation: Dermatology Clinic 2, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: G S
authors.initials: GS
authors.lastname: Tiplica
authors.affiliation: Department of Clinical Medicine, University of Applied Health Sciences, Zagreb, Croatia.
authors.forename: A
authors.initials: A
authors.lastname: Stanimirović
authors.affiliation: Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Niewada
authors.affiliation: Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University, Sofia, Bulgaria.
authors.forename: G
authors.initials: G
authors.lastname: Petrova
authors.affiliation: Department of Social Pharmacy and Pharmacoeconomics, Faculty of Pharmacy, Medical University, Sofia, Bulgaria.
authors.forename: L T
authors.initials: LT
authors.lastname: Marinov
authors.forename: J
authors.initials: J
authors.lastname: Kazandhieva
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.
authors.forename: M
authors.initials: M
authors.lastname: Péntek
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.
authors.forename: V
authors.initials: V
authors.lastname: Brodszky
authors.affiliation: Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.
authors.forename: L
authors.initials: L
authors.lastname: Gulácsi
mesh_terms: D001688:Biological Products / Q000191:economics / Q000627:therapeutic use*; D002031:Bulgaria / Q000453:epidemiology; D017523:Croatia / Q000453:epidemiology; D018153:Czech Republic / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017048:Health Care Costs; D006291:Health Policy; D006801:Humans; D006814:Hungary / Q000453:epidemiology; D019458:Insurance Coverage; D007348:Insurance, Health; D011044:Poland / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011565:Psoriasis / Q000188:drug therapy* / Q000453:epidemiology*; D012383:Romania / Q000453:epidemiology
chemical_list: D001688:Biological Products