Access to biologic and synthetic DMARDs, socio-economic welfare and disease status in all countries and in EU versus non-EU countries
| Mean (SD) (min–max) | EU versus non-EU member | |||
|---|---|---|---|---|
| 46 countries from European region | 27 EU member states | 19 non-EU member states | p Value* | |
| Availability | ||||
| Biologic DMARDs approved; number | 6.1 (2.4) (0–8) | 7.6 (0.9) (4–8) | 3.95 (2.34) (0–8) | 0.000† |
| Biologic DMARDs reimbursed; number | 4.9 (3.3) (0–8) | 6.9 (1.7) (2–8) | 2.11 (2.98) (0–8) | 0.000† |
| Reimbursement time; % of time since approval | 50 (40) (0–100) | 70 (30) (10–100) | 21 (35) (0–96) | 0.000† |
| Affordability | ||||
| Average price of available biologic DMARDs, euro/year | 14 166.8 (2789.5) (9430.8–21 349.2) | 14 200.5 (2435.7) (10 760.9–21 349.2) | 14 113.32 (3356.6) (9430.77–20 579.28) | 0.571 |
| Average price of available biologic DMARDs, int. $/year | 28 548.1 (10 768.5) (14 446.5–61 552.2) | 24 408.9 (7625.6) (14 446.5–45 531.8) | 35 122.1 (11 929.85) (18 382.89–61 552.15) | 0.001† |
| Patient contribution for available biologic DMARDs, euro/year | 3499.7 (5695.9) (0–18 790.3) | 675.5 (1784.1) (0–7512.5) | 7985.38 (6868.77) (0–18 790.28) | 0.001† |
| Patient contribution for available biologic DMARDs, int. $/year | 9974.6 (16 647.1) (0–61 552.2) | 1704.0 (4771.4) (0–21 065.0) | 23 110.12 (20 224.4) (0–61 552.15) | 0.001† |
| Average price of available synthetic DMARDs, euro/year | 257.7 (92.4) (100.1–498.1) | 260.8 (71.2) (170.1–461.7) | 253.32 (118.24) (100.06–498.14) | 0.938 |
| Average price of available synthetic DMARDs, int. $/year | 547.8 (332.5) (229.8–1812.5) | 451.1 (169.9) (232.4–864.6) | 685.21 (448.11) (229.77–1812.45) | 0.144 |
| Average patient contribution for available synthetic DMARDs, euro/year | 89.6 (100.0) (0–452.6) | 52.7 (63.8) (0–260.2) | 142.12 (119.02) (0–452.59) | 0.005† |
| Average patient contribution for available synthetic DMARDs, int. $/year | 220.7 (292.2) (0–1272.5) | 87.2 (98.9) (0–336.1) | 410.46 (366.84) (0–1272.5) | 0.001† |
| Ratio annual price of available biologic DMARDs/GDP per capita | 2.14 (2.51) (0.18–11.05) | 1.01 (0.73) (0.18–3.3) | 3.93 (3.25) (0.34–11.05) | 0.001† |
| Ratio annual personal contribution for available biologic DMARDs/minimum wage‡ | 0.32 (0.90) (0–3.98)‡ | 0.35 (0.94) (0–3.98)‡ | ‡ | ¶ |
| Ratio annual price of available synthetic DMARDs/GDP per capita | 0.04 (0.05) (0.003–0.23) | 0.02 (0.01) (0–0.06) | 0.08 (0.06) (0.005–0.23) | 0.000† |
| Ratio annual personal contribution for available synthetic DMARDs/minimum wage‡ | 0.01 (0.01) (0–0.06)‡ | 0.01 (0.01) (0–0.06)‡ | ‡ | ¶ |
| Days a person receiving minimum wage has to work to cover 30 days treatment with available biologic DMARDs‡ | 1038 (849) (235–3454)‡ | 1054 (891) (235–3454)‡ | ‡ | ¶ |
| Days a person receiving minimum wage has to work to cover 30 days treatment with available synthetic DMARDs‡ | 19 (16) (4–66)‡ | 19 (17) (4–66)‡ | ‡ | ¶ |
| Acceptability | ||||
| Average score on 6 barriers | 3.2 (2.1) (0–7.8) | 2.2 (1.3) (0–5) | 4.45 (2.23) (0.67–7.83) | 0.001† |
| Administration/financial barriers for prescribers | 5.1 (3.3) (0–10) | 4.2 (2.9) (0–10) | 6.42 (3.40) (0–10) | 0.026† |
| Amount of personal financial contribution from the patient | 3.0 (4.1) (0–10) | 1.1 (2.1) (0–10) | 5.74 (4.67) (0–10) | 0.002† |
| Lack of trust in the healthcare system from patients | 2.8 (2.7) (0–10) | 2.1 (2.2) (0–10) | 3.79 (3.07) (0–10) | 0.060 |
| General indicators | ||||
| Population, in millions | 18.9 (28.4) (0.3–141.8) | 18.6 (23.5) (0.4–81.7) | 19.30 (34.83) (0.32–141.75) | 0.390 |
| GDP per capita in 2010, int. $ | 24 804.3 (16 481.0) (2146.8–89 769.5) | 31 253.3 (14 557.6) (13 779.8–89 769.5) | 15 639.88 (14 896.6) (2146.81–56 894.05) | 0.000† |
| Median income in 2009, int. $§ | 21 033.2 (7902.2) (6062.5–38 729.1)§ | 19 942.5 (7542.4) (6062.5–38 729.1)§ | § | ¶ |
| Total health expenditure in 2008, int. $ | 2174.8 (1582.7) (95.0–5996.0) | 2812.6 (1305.8) (840.0–5996.0) | 1268.47 (1523.84) (95–5207) | 0.000† |
| DAS28** | 4.3 (0.9) (3.1–5.9) | 4.2 (0.8) (3.1–5.5) | ** | ¶ |
| Number of Swollen Joints28** | 4.3 (1.7) (1.6–7.4) | 4.1 (1.6) (1.6–7.1) | ** | ¶ |
| HAQ** | 1.1 (0.3) (0.6–1.6) | 1.1 (0.3) (0.6–1.5) | ** | ¶ |
*Comparison of 27 European Union (EU) members states versus 19 non-EU member states using Mann–Whitney test.
†Significant at 0.05 level.
‡n=22 (20 in EU).
§n=30 (27 in EU).
¶Data available for <=4 non-EU countries, reason for which no comparison between EU and non-EU countries was made.
**Data available for 21 countries, among them 17 are EU member states.5
DAS28, Disease Activity Score with 28-joint assessment; DMARD, disease-modifying antirheumatic drug; GDP, Gross Domestic Product; HAQ, Health Assessment Questionnaire; int. $, international dollars.