Background Clinical trials have proven the efficacy of biological therapy for rheumatoid arthritis (RA) worldwide. However, high costs have set boundaries to their use, especially in developing countries. Whereas in Europe, there are countries without any biological reimbursed, other countries have a more liberal prescription, regardless of the RA duration and previous therapy. To be eligible for biologics, in Romania, patients with active RA must be non-responders to at least two synthetic DMARDs; up to date four biological products are reimbursed: infliximab, etanercept, adalimumab, rituximab.
Objectives The aim of the study is to evaluate patients' accessibility to biological therapy on a national scale (41 counties and Bucharest, i.e. the capital) and its correlation with socio-economical indicators for each region.
Methods Cross-sectional study carried out in 41 counties and Bucharest. Data was gathered from the Romanian Registry of Rheumatic Diseases, while the socio-economic indicators were extracted from the yearbook of the National Institute for Statistics (EUROSTAT).
Results The sample comprised data of 4507 RA patients (4267 being treated with biologics and 240 being eligible for biologic therapy). The mean age was 56.69 yrs (±12.07), 85.24% women, 67.80% live in urban residences, with a mean RA duration of 12 yrs. 80.20% (n=3614) of patients had access to biologics in their county of residence, whereas 19.80% (n=893) of patients were treated elsewhere. The group treated outside of their county of residence come from areas with high deficit of physicians (1.67 physicians/1000 inhabitants, compared to 3.24 physicians/1000 inhabitants, for the group treated locally), and with decreased welfare (GDP/inhabitant: €6634.83, compared to €4891.02, p<0.001). The total number of rheumatologists working in a county varies from none (7 counties do not have any rheumatologist) to 75 (in Bucharest). There is a positive correlation between areas with better living conditions and the number of local working rheumatologists (r=0.54, p<0.01). Patients living in urban areas (70.20%) have significantly greater access to biologics in their county of residence compared to patients living in rural environments (29.7%), most of them being forced to travel in order to be taken into care by a rheumatologist. The patients' age does not impact on their access to biological therapy. On a national scale, the majority of RA patients who are treated outside their county of residence chose the capital, Bucharest: 53.73% [805/1498] of patients treated in Bucharest came from a different geographical area.
Conclusions In Romania, the accessibility of RA patients to biological therapy greatly varies according to the socio-economic situation of their county of residence. Living in an area with a low socio-economic status significantly decreases the patients' chances of getting treated with biologics compared to other national counties, even when therapeutic protocols are equal and equitable.
Disclosure of Interest : None declared