Published online Feb 14, 2015. doi: 10.3748/wjg.v21.i6.1728
Peer-review started: September 4, 2014
First decision: October 14, 2014
Revised: October 24, 2014
Accepted: December 1, 2014
Article in press: December 1, 2014
Published online: February 14, 2015
Biological drugs opened up new horizons in the management of inflammatory bowel diseases (IBD). This study focuses on access to biological therapy in IBD patients across 9 selected Central and Eastern European (CEE) countries, namely Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania and Slovakia. Literature data on the epidemiology and disease burden of IBD in CEE countries was systematically reviewed. Moreover, we provide an estimation on prevalence of IBD as well as biological treatment rates. In all countries with the exception of Romania, lower biological treatment rates were observed in ulcerative colitis (UC) compared to Crohn’s disease despite the higher prevalence of UC. Great heterogeneity (up to 96-fold) was found in access to biologicals across the CEE countries. Poland, Bulgaria, Romania and the Baltic States are lagging behind Hungary, Slovakia and the Czech Republic in their access to biologicals. Variations of reimbursement policy may be one of the factors explaining the differences to a certain extent in Bulgaria, Latvia, Lithuania, and Poland, but association with other possible determinants (differences in prevalence and incidence, price of biologicals, total expenditure on health, geographical access, and cost-effectiveness results) was not proven. We assume, nevertheless, that health deterioration linked to IBD might be valued differently against other systemic inflammatory conditions in distinct countries and which may contribute to the immense diversity in the utilization of biological drugs for IBD. In conclusion, access to biologicals varies widely among CEE countries and this difference cannot be explained by epidemiological factors, drug prices or total health expenditure. Changes in reimbursement policy could contribute to better access to biologicals in some countries.
Core tip: Great heterogeneity ranging up to 96-fold difference in access of inflammatory bowel diseases (IBD) patients to biologicals can be found across Central and Eastern Europe (CEE): Poland, Bulgaria, Romania, and the Baltic States have, to date, fallen behind Hungary, Slovakia and the Czech Republic. The following factors did not explain the considerable variations among the CEE countries: differences in prevalence and incidence, price of biologicals, total expenditure on health, geographical access, clinical guidelines, and cost-effectiveness results. We assume that health deterioration linked to IBD might be valued differently against other systemic inflammatory conditions in distinct countries which contributes to the great heterogeneity.