Disparities in the organisation of national healthcare systems for treatment of patients with psoriatic arthritis and axial spondyloarthritis across Europe
(2025) In Health Policy 156.- 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... (More)
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.
(Less)
- author
- organization
- publishing date
- 2025-06
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Access to health care, Axial spondyloarthritis, Biologic therapy, Health policy, Psoriatic arthritis, Socioeconomic health disparities
- in
- Health Policy
- volume
- 156
- article number
- 105311
- publisher
- Elsevier
- external identifiers
-
- scopus:105002648844
- pmid:40245675
- ISSN
- 0168-8510
- DOI
- 10.1016/j.healthpol.2025.105311
- language
- English
- LU publication?
- yes
- id
- a573f821-7878-4cbc-9b51-062644855cef
- date added to LUP
- 2025-08-08 08:10:26
- date last changed
- 2025-08-22 09:21:56
@article{a573f821-7878-4cbc-9b51-062644855cef,
abstract = {{<p>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.</p>}},
author = {{Michelsen, Brigitte and Østergaard, Mikkel and Nissen, Michael John and Ciurea, Adrian and Möller, Burkhard and Midtbøll Ørnbjerg, Lykke and Horák, Pavel and Glintborg, Bente and MacDonald, Alan and Laas, Karin and Sokka-Isler, Tuulikki and Gudbjornsson, Bjorn and Iannone, Florenzo and Hellamand, Pasoon and Kvien, Tore Kristian and Rodrigues, Ana Maria and Codreanu, Catalin and Rotar, Ziga and Castrejón, Isabel and Wallman, Johan Karlsson and Pavelka, Karel and Loft, Anne Gitte and Heddle, Maureen and Vorobjov, Sigrid and Relas, Heikki and Gröndal, Gerdur and Gremese, Elisa and van der Horst-Bruinsma, Irene and Kristianslund, Eirik Klami and Santos, Maria José and Mogosan, Corina and Tomsic, Matija and Diaz-Gonzalez, Federico and Giuseppe, Daniela Di and Nielsen, Stig Winther and Hetland, Merete Lund}},
issn = {{0168-8510}},
keywords = {{Access to health care; Axial spondyloarthritis; Biologic therapy; Health policy; Psoriatic arthritis; Socioeconomic health disparities}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{Health Policy}},
title = {{Disparities in the organisation of national healthcare systems for treatment of patients with psoriatic arthritis and axial spondyloarthritis across Europe}},
url = {{http://dx.doi.org/10.1016/j.healthpol.2025.105311}},
doi = {{10.1016/j.healthpol.2025.105311}},
volume = {{156}},
year = {{2025}},
}