The European Journal of Health Economics

, Volume 14, Issue 6, pp 875–885 | Cite as

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

  • P. A. LairesEmail author
  • F. Exposto
  • R. Mesquita
  • A. P. Martins
  • L. Cunha-Miranda
  • J. E. Fonseca
Original Article



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


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.


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.


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.


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.


Rheumatoid arthritis Treatment access Biologics Portugal 

JEL Classification




The authors would like to thank Luís Veloso for critical review of this paper. The study was funded by Merck Sharp & Dohme.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • P. A. Laires
    • 1
    Email author
  • F. Exposto
    • 2
  • R. Mesquita
    • 3
  • A. P. Martins
    • 1
  • L. Cunha-Miranda
    • 4
  • J. E. Fonseca
    • 5
  1. 1.Outcomes ResearchMerck Sharp & DohmePaço de ArcosPortugal
  2. 2.IMS HealthOeirasPortugal
  3. 3.Medical AffairsMerck Sharp & DohmeOeirasPortugal
  4. 4.Department of RheumatologyInstituto Português de ReumatologiaLisbonPortugal
  5. 5.Rheumatology Research UnitInstituto de Medicina Molecular da Faculdade de Medicina da Universidade de LisboaLisbonPortugal

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