Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2015; 21(6): 1728-1737
Published online Feb 14, 2015. doi: 10.3748/wjg.v21.i6.1728
Biological therapy in inflammatory bowel diseases: Access in Central and Eastern Europe
Fanni Rencz, Márta Péntek, Martin Bortlik, Edyta Zagorowicz, Tibor Hlavaty, Andrzej Śliwczyński, Mihai M Diculescu, Limas Kupcinskas, Krisztina B Gecse, László Gulácsi, Peter L Lakatos
Fanni Rencz, Márta Péntek, László Gulácsi, Department of Health Economics, Corvinus University of Budapest, H-1093 Budapest, Hungary
Fanni Rencz, Semmelweis University Doctoral School of Clinical Medicine, H-1085 Budapest, Hungary
Martin Bortlik, IBD Clinical and Research Centre, ISCARE a.s., 1st Faculty of Medicine, Charles University, 170004 Prague, Czech Republic
Edyta Zagorowicz, Department of Gastroenterology, The Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology and Medical Center for Postgraduate Education, 01-813 Warsaw, Poland
Tibor Hlavaty, Gastroenterology Unit, Department of Internal Medicine V, University Hospital Bratislava, SK-82606 Bratislava, Slovakia
Andrzej Śliwczyński, Public Health Department, Health Sciences Faculty, Medical University in Łódź and National Health Fund, 02-390 Warsaw, Poland
Mihai M Diculescu, Department of Gastroenterology and Hepatology, Carol Davila University, 020022 Bucharest, Romania
Limas Kupcinskas, Department of Gastroenterology, Medical Academy, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania
Krisztina B Gecse, Péter L Lakatos, 1st Department of Medicine, Semmelweis University, H-1083 Budapest, Hungary
Author contributions: Gulácsi L and Lakatos PL equally contributed to the paper and were involved in all activities including the design, epidemilogy and antTNF acess data collection, data analysis and drafting and revising the manuscript; Renz F and Péntek M were involved in data analysis and drafting and revising the manuscript; all other authors were involved in drafting and revising the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Péter L Lakatos, MD, DSc, PhD, 1st Department of Medicine, Semmelweis University, Korányi S. 2/A, H-1083 Budapest, Hungary.
Telephone: +36-1-2100278 Fax: +36-1-310250
Received: September 3, 2014
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.

Keywords: Inflammatory bowel diseases, Ulcerative colitis, Biological therapy, Access, Europe, Central and Eastern, Crohn’s disease

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.