PoliticalSpeak: health inequalities in Europe

Will staying in the EU reduce health inequality across Europe? #MSBlog #Brexit #Bremain #PoliticalSpeak

“As we approach Bremain, or Brexit, it is worth pondering the EU from the perspective of a patient. The study below highlights the inequality in prescribing of biological therapies for chronic inflammatory conditions; in the case below the example is rheumatological diseases. I always thought inequality in prescribing of expensive biological therapies was linked to per capita income. This study shows that in Eastern Europe this is not the case and based on similar data in relation to MS DMTs it is not closely linked to GDP. For example, the UK is near the bottom of most EU MS DMT league tables. Therefore inequality in prescribing, must be driven by local and cultural factors, for example the slow adoption of innovations. In the era when most people with a chronic disease have information at their fingertips via the internet it should come as no surprise that access to expensive therapies across the border is a potential incentive for EU migration. I sincerely hope after the UK votes to stay in the EU on Thursday we get the MEPs to address health inequality across our continent. If we exit the EU we will almost certainly remain at the bottom of the MS DMT league tables. A commitment to improve the lives of people with chronic diseases, and address healthcare inequalities, including MS, is something I would expect from the EU. I doubt these issues would be a major priority outside the EU.”

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.

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

1 comment

  • I've had MS for years and I now have Eastern European Physiotherapists. I couldn't wish for kinder, helpful people. I don't care where they come from, it's their skills and compassion that matters. I hope we stay in.

By Prof G



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