Many of Europe’s nearly 2 million rheumatoid arthritis patients are still unable to access effective new biologic treatments, and whether they can do so or not is largely dependent on where they live, says a new study.

The percentage of patients diagnosed with RA who are treated with biologics ranges from 30% in Norway to less than 1% in Bulgaria, according to the report, which looks at access to treatment in 30 European countries (the 27 members of the European Union plus Iceland, Norway and Switzerland) and has been published in the European Journal of Health Economics.

The study puts the total annual cost of treating the disease in the 30 nations at 25.1 billion euros, with costs per patient averaging 15,000 euros in western Europe and 3,750 euros in central and eastern Europe.

Few health care areas have seen the level of medical progress experienced by RA, it says, with the biggest breakthrough coming in the late 1990s with the introduction of the tumour necrosis factor (TNF) inhibitors, which not only effectively control inflammation but can also prevent or slow the development of irreversible joint erosion.

As truly disease-modifying agents, TNF inhibitors should ideally be used as early as possible in the course of the disease, but their side-effect profile has led to “a cautious initial use,” and their widespread use has also been hampered by their cost, says the study.

The largest differences in access are due to a global price for the drugs and large differences in wealth among the 30 nations, says the study. Standardised drug prices caused by Europe’s regulatory environment, plus the relationship between Gross Domestic Product (GDP) and expenditures, leads to a large difference in affordability between western Europe and the new EU member states, it notes.

Health Technology Assessment (HTA) studies and economic evaluations also have an effect; a treatment priced at 10,000-15,000 euros will lead to different cost-effectiveness results in countries where the total annual cost per patient averages from 500 euros for patients with early and mild disease to 5,000 for those with advanced severe disease, compared to countries where this total range is between 3,500 euros and 35,000 euros.

Moreover, countries have different views as to how cost-effective the THF inhibitors are, the researchers note. Countries such as Norway and Sweden regard them as representing good value for money, while others, such as the UK, have evaluated them less favourably, and their use there is more restricted.

Another of the most important factors explaining differences in uptake of innovative treatments is “insufficient consideration being given to societal costs in authorities’ public health strategies, despite these representing more than half of all disease cost,” says Dr Gisela Kobelt, President of European Health Economics, France and the report’s lead researcher.

The study was supported by an unrestricted grant from the European Federation of Pharmaceutical Industries and Associations (EFPIA), which pointed out that the report’s publication yesterday, on World Arthritis Day, was “particularly appropriate.”

Its findings help “shed light on the reasons why patients face these inequalities in access to RA treatments. We hope it will stimulate discussions on how we achieve the optimal use of new technologies and treatment for all patients,” said EFPIA director general Brian Ager.