Background In the drug treatment for RA patients, EULAR recommends to initiate synthetic DMARDs immediately after diagnosis. However, it is questionable whether these treatments are equally available and affordable across European countries. If recommended care implies higher economic burden, recommendations might be poorly adhered to, contributing to health disparities.
Objectives To explore the availability and affordability of synthetic DMARDs for treatment of RA across Europe.
Methods Availability and prices of synthetic DMARDs (MTX, LEFL, SSZ, HDX/Chloroq and PRED), as well as amount of co-payments, were collected by a questionnaire sent to a representative rheumatologist in 48 countries of the European region. Data on RA health status (DAS28, HAQ, TJC, SJC, ESR) were retrieved from the literature (Quest RA). Data on socio-economic welfare (gross domestic product (GDP), health expenditure, median income and minimum wage) were retrieved from web-based sources. To ensure comparability, national prices were converted into international dollars ($) to adjust for the countries’ purchasing power parity (PPP).An affordability index (ratio between co-payments and minimum wage) was calculated. Prices and co-payments were correlated with indicators of welfare and RA health status using Spearman correlations.
Results Forty-six countries (response rate 96%) provided data. Of the 5 drugs surveyed, MTX and SSZ were available in all the countries, and only Uzbekistan had less than 4 drugs available. Average annual prices of available DMARDs ranged from €100 to 498 (price ratio 4.98). After adjusting the prices for PPP, they ranged from int.$230 to int.$1812 (price ratio 7.9). In 7 countries (Armenia, Georgia, Kazakhstan, Russia, Tajikistan, Ukraine, Uzbekistan), no public reimbursement schemes were available. In 38 countries some form of personal contribution existed. The cost of 30 days treatment with available DMARDs, expressed as the number of calendar days a person receiving the minimum salary would have to work to cover this cost assuming no reimbursement, ranged from 0.30 (Luxemburg) to 5.47 (Bulgaria). Negative associations were found between the prices (adjusted to PPP) and the affordability index with welfare indicators. Prices and affordability index were also positively correlated with RA disease activity (table).
Conclusions Treatment with synthetic DMARDs is less affordable in lower income European countries. In countries where co-payments exist, there is an additional disadvantage for persons with low income. The data suggest that lower availability and affordability result in poorer RA health status.
Sokka T et al. Ann Rheum Dis 2009;68,1666-72
Disclosure of Interest None Declared