Background: Biological agents revolutionised the treatment of chronic inflammatory diseases such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA) as well as Crohn’s disease (CD), ulcerative colitis (UC) and psoriasis. RA studies highlighted that uptake of biologic drugs varies strongly across Europe and the income of a country is considered as a major determinant factor for usage. It has been found that access to biologics in RA—expressed as a composite score of availability, affordability and acceptability—showed a strong positive correlation with gross domestic product (GDP)/capita (r=0.86) in Europe. Much less is known on this topic in AS, PsA and the other three inflammatory diseases.
Methods: We analysed real-world biologic usage data and their relationships with GDP/capita in the six inflammatory conditions in Bulgaria, the Czech Republic, Hungary, Poland, Romania and Slovakia. According to our previous literature search, there is no precise and comparable country-specific prevalence data in this region.Therefore, we estimated the biologic treatment rates per 100 000 inhabitants.
Results: Considering the total of six diagnoses, we found only moderate positive correlation (r=0.34, p=0.506) between biologic usage and GDP/capita levels. An approximately eightfold difference in treatment rate was observed between Hungary and Poland despite their almost identical GDP/capita. Similar treatment rates were found in Romania and the Czech Republic, in contrast to the over twice as high GDP/capita of the latter.
Conclusions: Overall, inequity in access to biologics is apparent and can be observed in rheumatology. Although our analyses were performed in Central and Eastern Europe, we assume that similar inequities might occur in other European regions as well.