Access to biologicals in Crohn's disease in ten European countries

Marta Pentek, Peter L. Lakatos, Talitha Oorsprong, Laszlo Gulacsi*, Milena Pavlova, Wim Groot, Fanni Rencz, Valentin Brodszky, Petra Baji, Crohn's Dis Res Grp

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

23 Citations (Web of Science)

Abstract

AIM

To analyze access (availability, affordability and acceptability) to biologicals for Crohn's disease (CD) in ten European countries and to explore the associations between these dimensions, the uptake of biologicals and economic development.

METHODS

A questionnaire-based survey combined with desk research was carried out in May 2016. Gastroenterologists from the Czech Republic, France, Germany, Hungary, Latvia, Poland, Romania, Slovakia, Spain and Sweden were invited to participate and provide data on the availability of biologicals/biosimilars, reimbursement criteria, clinical practice and prices, and use of biologicals. An availability score was developed to evaluate the restrictiveness of eligibility and administrative criteria applied in the countries. Affordability was defined as the annual cost of treatment as a share of gross domestic product (GDP) per capita. Correlations with the uptake of biologicals, dimensions of access and GDP per capita were calculated.

RESULTS

At the time of the survey, infliximab and adalimumab were reimbursed in all ten countries, and vedolizumab was reimbursed in five countries (France, Germany, Latvia, Slovakia, Sweden). Reimbursement criteria were the least strict in Sweden and Germany, and the strictest in Hungary, Poland and Slovakia. Between countries, the annual cost of different biological treatments differed 1.6-3.3-fold. Treatments were the most affordable in Sweden (13%-37% of the GDP per capita) and the least affordable in the Central and Eastern European countries, especially in Hungary (87%-124%) and Romania (141%-277%). Biosimilars made treatments more affordable by driving down the annual costs. The number of patients with CD on biologicals per 100000 population was strongly correlated with GDP per capita (0.91), although substantial differences were found in the uptake among countries with similar economic development. Correlation between the number of patients with cd on biologicals per 100000 population and the availability and affordability was also strong (-0.75, -0.69 respectively).

CONCLUSION

Substantial inequalities in access to biologicals were largely associated with GDP. To explain differences in access among countries with similar development needs further research on acceptance.

Original languageEnglish
Pages (from-to)6294-6305
Number of pages12
JournalWorld Journal of Gastroenterology
Volume23
Issue number34
DOIs
Publication statusPublished - 14 Sep 2017

Keywords

  • Crohn's disease
  • Biological therapy
  • Access
  • Inequality
  • Europe
  • INFLAMMATORY-BOWEL-DISEASE
  • RHEUMATOID-ARTHRITIS
  • ULCERATIVE-COLITIS
  • THERAPY
  • DRUGS
  • METAANALYSIS
  • BURDEN
  • LIFE

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