Patients' access to biologics in rheumatoid arthritis: a comparison between Portugal and other European countries

Eur J Health Econ. 2013 Dec;14(6):875-85. doi: 10.1007/s10198-012-0432-5. Epub 2012 Sep 18.


Background: Despite the widespread availability of biologics across Europe, rheumatoid arthritis (RA) patients' access to these drugs differs significantly among countries.

Objectives: To compare the proportion of RA patients treated with biologics across Europe and investigate the factors that most influence it, with focus on the Portuguese case, reportedly with low access rates to biologics.

Methods: The biologics' market was characterized for 15 selected European countries. Variables potentially influencing patients' access to biologics (PAB) in RA were also collected, including demographic, disease, economic, funding and biologics' market-related data. A multivariable regression model identified the factors that best explain PAB. Based on these determinants, a cluster analysis was performed to group the countries with most similar behaviour regarding PAB allowing the evaluation of Portugal's relative position among these countries.

Results: The regression model (R(2) = 0.953) indicated that PAB in selected countries is explained mostly by its gross domestic product (GDP) per capita, the usage of methotrexate (MTX) and the biologics' distribution channel. Current MTX usage in Portugal shows similarity with practice from UK, France, Germany or Spain 5 years before, explaining why PAB in Portugal stood at 7% in 2010, 12 percentage points below the average of selected countries.

Conclusions: Variations in RA PAB were found across selected countries with Portugal showing the lowest proportion. GDP per capita, biologics distribution channel and consumption of MTX appear to be the best explanatory factors for these fluctuations in European countries.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antirheumatic Agents / economics
  • Antirheumatic Agents / supply & distribution
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / economics*
  • Biological Products / economics
  • Biological Products / supply & distribution
  • Biological Products / therapeutic use*
  • Europe
  • Health Expenditures
  • Health Services Accessibility / economics
  • Health Services Accessibility / organization & administration*
  • Humans
  • Methotrexate / therapeutic use
  • Portugal
  • Socioeconomic Factors


  • Antirheumatic Agents
  • Biological Products
  • Methotrexate