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. 2011 Apr;17(4):SR1-13.
doi: 10.12659/msm.881697.

Access to biologic treatment for rheumatoid arthritis in Central and Eastern European (CEE) countries

Ewa Orlewska  1 , Ioan Ancuta, Branimir Anic, Catalin Codrenau, Nemanja Damjanov, Predrag Djukic, Ruxandra Ionescu, Lubomir Marinchev, Evgeny L Nasonov, Tonu Peets, Sonja Praprotnik, Rasho Rashkov, Jana Skoupa, Witold Tlustochowicz, Malgorzata Tlustochowicz, Matija Tomsic, Tiina Veldi, Jelena Vojinovic, Piotr Wiland
Affiliations

Access to biologic treatment for rheumatoid arthritis in Central and Eastern European (CEE) countries

Ewa Orlewska et al. Med Sci Monit. 2011 Apr.

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.

Material/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.

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Figures

Figure 1
Figure 1
Number of RA patients.
Figure 2
Figure 2
Number of patients seen weekly in practice by rheumatologists in several CEE countries.
Figure 3
Figure 3
Percentage of RA patients on biologic treatment.
Figure 4
Figure 4
Etanercept in selected CEE countries: number of pack per 1000 inhabitants.
Figure 5
Figure 5
Infliximab in selecetd CEE countries: number of pack per 1000 inhabitants.
Figure 6
Figure 6
Adalimumab in selected CEE countries: number of pack per 1000 inhabitants.
See this image and copyright information in PMC

References

    1. Sokka T, Kautiainen H, Pincus T, et al. Disparities in rheumatoid arthritis disease activity according to gross domestic product in 25 countries in the QUEST-RA database. Ann Rheum Dis. 2009;68(11):1666–72. - PMC - PubMed
    1. Hanova P, Pavelka K, Dostal C, et al. Epidemiology of rheumatoid arthritis, juvenile idiopathic arthritis and gout in two regions of the Czech Republic in a descriptive population-based survey in 2002–2003. Clin Exp Rheumatol. 2006;24(4):499–507. - PubMed
    1. Otsa K, Tammaru M, Vorobjov S, et al. The prevalence of rheumatoid arthritis (RA) in Harju County, Estonia. EULAR. 2009 Abstract FRI0517. - PubMed
    1. Kiss CG, Lovei C, Suto G, et al. Prevalence of rheumatoid arthritis in the South-Transdanubian region of Hungary based on a representative survey of 10,000 inhabitants. J Rheumatol. 2005;32(9):1688–90. - PubMed
    1. Péntek M, Kobelt G, Czirják L, et al. Costs of rheumatoid arthritis in Hungary. J Rheumatol. 2007;34(6):1437–38. - PubMed

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