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Review
. 2025 Jun:156:105311.
doi: 10.1016/j.healthpol.2025.105311. Epub 2025 Apr 4.

Disparities in the organisation of national healthcare systems for treatment of patients with psoriatic arthritis and axial spondyloarthritis across Europe

Brigitte Michelsen  1 , Mikkel Østergaard  2 , Michael John Nissen  3 , Adrian Ciurea  4 , Burkhard Möller  5 , Lykke Midtbøll Ørnbjerg  6 , Pavel Horák  7 , Bente Glintborg  8 , Alan MacDonald  9 , Karin Laas  10 , Tuulikki Sokka-Isler  11 , Bjorn Gudbjornsson  12 , Florenzo Iannone  13 , Pasoon Hellamand  14 , Tore Kristian Kvien  15 , Ana Maria Rodrigues  16 , Catalin Codreanu  17 , Ziga Rotar  18 , Isabel Castrejón  19 , Johan Karlsson Wallman  20 , Karel Pavelka  21 , Anne Gitte Loft  22 , Maureen Heddle  23 , Sigrid Vorobjov  24 , Heikki Relas  25 , Gerdur Gröndal  26 , Elisa Gremese  27 , Irene van der Horst-Bruinsma  28 , Eirik Klami Kristianslund  15 , Maria José Santos  29 , Corina Mogosan  17 , Matija Tomsic  18 , Federico Diaz-Gonzalez  30 , Daniela Di Giuseppe  31 , Stig Winther Nielsen  32 , Merete Lund Hetland  2
Affiliations
Free article
Review

Disparities in the organisation of national healthcare systems for treatment of patients with psoriatic arthritis and axial spondyloarthritis across Europe

Brigitte Michelsen et al. Health Policy. 2025 Jun.
Free article

Abstract

Background: Studies on national policies for biologics are warranted.

Objectives: To map and compare national healthcare set-ups for prescription, start, switch, tapering, and discontinuation of biologic/targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with psoriatic arthritis and axial spondyloarthritis across Europe, and assess the healthcare set-ups in relation to countries' socio-economic status.

Methods: An electronic survey was developed to collect and compare information on national healthcare systems. The relationship between the cumulative score of biologic/targeted synthetic DMARD regulations, socioeconomic indices, and biologic originator costs were assessed by linear regression.

Results: National healthcare set-ups differed considerably across the 15 countries, with significantly fewer regulations with increasing socioeconomic status measured by GDP/current health expenditure/human development index, and with increasing biologic originator costs. In most countries, the biologic/targeted synthetic DMARD prescribing doctor was required to adhere to country and/or hospital recommendations, and about a third of countries had a national/regional tender process. Prescription regulations for biologic/targeted synthetic DMARDs, including pre-treatment and disease activity requirements, varied substantially. Approximately a third of countries had criteria for discontinuation and tapering, whereas only few had for switching. Notably, two countries disallowed biologic/targeted synthetic DMARD retrials, and one imposed limit on the maximum number of biologic/targeted synthetic DMARDs permitted.

Conclusion: The findings highlight substantial variability in healthcare set-ups for biologic/targeted synthetic DMARD use in psoriatic arthritis and axial spondyloarthritis across Europe and their association with socioeconomic status and drug costs. These insights provide a basis for rheumatology societies, policymakers, and stakeholders to evaluate and potentially optimize healthcare policies.

Keywords: Access to health care; Axial spondyloarthritis; Biologic therapy; Health policy; Psoriatic arthritis; Socioeconomic health disparities.

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Conflict of interest statement

Declaration of competing interest BM, research grant from Novartis (for the present manuscript, paid to employer), honoraria for presentation from Novartis, Centre for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY) is funded as a Centre for Clinical Treatment Research by The Research Council of Norway (project 328657); MØ: Research grant from Novartis paid to institution for the present manuscript, research funding from Abbvie, BMS, Merck, Novartis and UCB, consulting fees from Abbvie, BMS, Celgene, Eli-Lilly, Janssen, Merck, Novartis, Pfizer, UCB, speaker's bureaus from Abbvie, BMS, Eli-Lilly, Janssen, MEDAC, Merck, Novartis, Pfizer and UCB; MJN: Research grant from Novartis paid to institution; consulting fees, honoraria for lectures/ presentations or advisory board participation from Abbvie, Amgen, Eli-Lilly, Janssen, Novartis, Pfizer with payment to institution; support for attending meetings from Janssen and USB; AC: None; BMö: None; LMØ: Research grant paid to employer from Novartis; PHo: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, Abbvie, Eli-Lilly, Sobi, UCB, Amgen, Boehringer, Pfizer, Support for attending meetings and/or travel from UCB, Boehringer and Pfizer, participation on a Data Safety Monitoring Board or Advisory Board from Novartis, Abbvie, Eli-Lilly, Sobi, UCB, Amgen, Boehringer; BeG: Research grants (paid to institution) from AbbVie, Sandoz, Pfizer, BMS, chair of the DANBIO steering committee; AMD: None; KL: Honoraria for lectures from Novartis and Abbvie, support for attending EULAR 2021 from Pfizer and for attending ACR 2022 from Abbvie; TSI: Research grant from Amgen (paid to the institution), honoraria from Nordic Pharma; BjG: Consulting fees from Novartis, honoraria for lectures from Novartis and Nordic Pharma; FI: Consulting fees from Abbvie and UCB, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Astra-Zeneca, Galapagos, GSK, Eli-Lilly, Janssen and UCB; PHe: Research grant from Novartis paid to employer; TKK: fees for speaking and/or consulting last 3 years from AbbVie, Gilead, Grünenthal, Janssen, Novartis, Pfizer, Sandoz, UCB, and received research funding to Diakonhjemmet Hospital from AbbVie, BMS, Galapagos, Novartis, Pfizer and UCB; AMR: Consulting and/or speaking fees from Abbvie and Amgen, research grant from Novartis, Pfizer and Amgen; CC: None; ZR: speaker or consultancy fee from Abbvie, Amgen, AstraZeneca, Boehringer, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Roche, Sandoz Lek, SOBI, SwixxBioPharma; IC: Consulting fees from Pfizer and Galapagos, Payment or honoraria for lectures, presentations, Speakers bureaus, manuscript writing or educational events from GSK, Lilly, BMS, support for attending meetings and/or travel from UCB; JKW: research support (unrelated to the present manuscript) from AbbVie, Amgen, Eli Lilly, Novartis, Pfizer, Speakers´s bureau fees from AbbVie, Amgen, Acting co-chair of the Swedish Society for Rheumatology´s working group annually updating Swedish treatment recommendations for axial spondyloarthritis and psoriatic arthritis; KP: None; AGL: Consultancy and speakers fees from Novartis, Pfizer and UCB; MH: None; SV: None; HR: Payment for lecture from UCB, support for congress from Janssen, advisory board from Abbvie and Pfizer; GG: None; EG: None; IvdHB: consulting/speaker's fees from UCB, Lilly, AbbVie, MSD, BMS, Novartis and travel support for EULAR 2023 from Pfizer; EKK: None; MJS speakers fees from AbbVie, AstraZeneca, Janssen, Lilly, Medac, Novartis, Pfizer; CM: None; MT: Consulting and/or speaking fees from Abbvie, Amgen, Biogen, Eli Lilly, Janssen, Medis, MSD, Novartis, Pfizer, Sanofi, Sandoz-Lek; FDG: research support from Janssen, consulting fees from Sanofi, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Galapagos, payment for expert testimony from Pfizer, support for attending meetings and/or travel from Pfizer and Astra Zeneca, Advisory Board from Abbvie, receipt of equipment, materials, drugs, medical writing, gifts or other services from Novartis; DDG: None; SWN: None; MLH: Research grant paid to institution from AbbVie, Biogen, BMS, Celltrion, Eli Lilly, Janssen Biologics B.V., Lundbeck Foundation, MSD, Pfizer, Roche, Samsung Biopies, Sandoz, Novartis, Nordforsk, Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events (paid to institution) from Pfizer, Medac, Sandoz, participation on a Data Safety Monitoring Board or Advisory Board from Abbvie, MLH has chaired the steering committee of the Danish Rheumatology Quality Registry (DANBIO, DRQ), which receives public funding from the hospital owners and funding from pharmaceutical companies. MLH co-chairs EuroSpA, which generates real-world evidence of treatment of psoriatic arthritis and axial spondylorthritis based on secondary data and is partly funded by Novartis.

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