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Regional Differences in the Prescription of Biologics for Psoriasis in Sweden : A Register-Based Study of 4168 Patients

Calara, Paul S; Althin, Rikard; Carlsson, Katarina Steen LU and Schmitt-Egenolf, Marcus (2017) In BioDrugs 31(1). p.75-82
Abstract

Background: Observational studies suggest an inequitable prescription of biologics in psoriasis care, which may be attributed to geographical differences in treatment access. Sweden regularly ranks high in international comparisons of equitable healthcare, and is, in connection with established national registries, an ideal country to investigate potential inequitable access. Objective: The aim was to determine whether the opportunity for patients to receive biologics depends on where they receive care. Methods: Biologic-naïve patients enrolled in the Swedish National Register for Systemic Treatment of Psoriasis (PsoReg) from 2008 to 2015 (n = 4168) were included. The association between the likelihood of initiating a biologic and the... (More)

Background: Observational studies suggest an inequitable prescription of biologics in psoriasis care, which may be attributed to geographical differences in treatment access. Sweden regularly ranks high in international comparisons of equitable healthcare, and is, in connection with established national registries, an ideal country to investigate potential inequitable access. Objective: The aim was to determine whether the opportunity for patients to receive biologics depends on where they receive care. Methods: Biologic-naïve patients enrolled in the Swedish National Register for Systemic Treatment of Psoriasis (PsoReg) from 2008 to 2015 (n = 4168) were included. The association between the likelihood of initiating a biologic and the region where patients received care was analyzed. The strength of the association was adjusted for patient and clinical characteristics, as well as disease severity using logistic regression analysis. The proportion of patients that switched to a biologic (switch rate) and the probability of switch to a biologic was calculated in 2-year periods. Results: The national switch rate increased marginally over time from 9.7 to 11.0%, though the uptake varied across regions. Adjusted odds ratios for at least one region were significantly different from the reference region in every 2-year period. During the latest period (2014–2015), the average patient in the lowest prescribing region was nearly 2.5 times less likely to switch as a similar patient in the highest prescribing region. Conclusions: Geographical differences in biologics prescription persist after adjusting for patient characteristics and disease severity. The Swedish example calls for further improvements in delivering equitable psoriasis care.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
BioDrugs
volume
31
issue
1
pages
75 - 82
publisher
Adis International
external identifiers
  • scopus:85009820856
  • wos:000393693000005
ISSN
1173-8804
DOI
10.1007/s40259-016-0209-y
language
English
LU publication?
yes
id
bb8ab35b-bb12-4c64-89f6-8a222b438abb
date added to LUP
2017-02-06 10:28:33
date last changed
2018-01-07 11:48:36
@article{bb8ab35b-bb12-4c64-89f6-8a222b438abb,
  abstract     = {<p>Background: Observational studies suggest an inequitable prescription of biologics in psoriasis care, which may be attributed to geographical differences in treatment access. Sweden regularly ranks high in international comparisons of equitable healthcare, and is, in connection with established national registries, an ideal country to investigate potential inequitable access. Objective: The aim was to determine whether the opportunity for patients to receive biologics depends on where they receive care. Methods: Biologic-naïve patients enrolled in the Swedish National Register for Systemic Treatment of Psoriasis (PsoReg) from 2008 to 2015 (n = 4168) were included. The association between the likelihood of initiating a biologic and the region where patients received care was analyzed. The strength of the association was adjusted for patient and clinical characteristics, as well as disease severity using logistic regression analysis. The proportion of patients that switched to a biologic (switch rate) and the probability of switch to a biologic was calculated in 2-year periods. Results: The national switch rate increased marginally over time from 9.7 to 11.0%, though the uptake varied across regions. Adjusted odds ratios for at least one region were significantly different from the reference region in every 2-year period. During the latest period (2014–2015), the average patient in the lowest prescribing region was nearly 2.5 times less likely to switch as a similar patient in the highest prescribing region. Conclusions: Geographical differences in biologics prescription persist after adjusting for patient characteristics and disease severity. The Swedish example calls for further improvements in delivering equitable psoriasis care.</p>},
  author       = {Calara, Paul S and Althin, Rikard and Carlsson, Katarina Steen and Schmitt-Egenolf, Marcus},
  issn         = {1173-8804},
  language     = {eng},
  month        = {02},
  number       = {1},
  pages        = {75--82},
  publisher    = {Adis International},
  series       = {BioDrugs},
  title        = {Regional Differences in the Prescription of Biologics for Psoriasis in Sweden : A Register-Based Study of 4168 Patients},
  url          = {http://dx.doi.org/10.1007/s40259-016-0209-y},
  volume       = {31},
  year         = {2017},
}