US health care disparities in immunology biologics access: a systematic review

Abstract

Objectives: Biologics have substantially improved health outcomes for patients with immunologic conditions. However, not all patients have equitable access to these important medications. Accordingly, we conducted a systematic review to understand US health care disparities in biologics access and associated clinical and economic outcomes, including health care resource use, across immunology (ie, rheumatology, gastroenterology, and dermatology).

Study design: Systematic literature review.

Methods: We searched PubMed, Web of Science, and Embase databases for studies published between 2017 and 2023 focused on access to biologic treatments for US adult patients (≥ 18 years) diagnosed with immunologic conditions.

Results: Across the 21 studies included in this systematic review, disparities in biologics access were inconsistently studied, and only 8 studies (38%) evaluated clinical or economic outcomes of low biologics access. The factors most frequently associated with disparities in access to biologics included insurance type; Black, Hispanic, or Asian race or ethnicity; high out-of-pocket costs; and insurance prior authorization requirements. These disparities were associated with worse clinical and economic outcomes, including higher hospital admission and readmission, higher number of emergency department visits, and treatment delays. However, some studies found no association between some of these disparities and access to biologics, highlighting the complexity of the issue.

Conclusions: We identified key factors that influence disparities in biologics access within immunology across the US, which were associated with worse clinical and economic outcomes. We highlight potential solutions to minimize disparities in biologics access and the need for more in-depth research to address these disparities.