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Inequity in biological DMARD prescription for spondyloarthritis across the globe : results from the ASAS-COMOSPA study

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Abstract
Objectives: The value of biological disease-modifying antirheumatic drugs (bDMARDs) in spondyloarthritis (SpA) is well recognised, but global access to these treatments can be limited due to high costs and other factors. This study explores country variation in the use of bDMARDs in SpA in relation to country-level socioeconomic factors. Methods: Patients fulfilling the Assessment in SpondyloArthritis International Society (ASAS) SpA criteria in the multinational, cross-sectional ASAS Comorbidities in Spondyloarthritis study were studied. Current use of bDMARDs or conventional synthetic DMARDs (csDMARDs) was investigated in separate models, with multilevel logistic regression analysis, taking the country level into account. Contribution of socioeconomic factors, including country health expenditures, gross domestic product and human development index as independent country-level factors, was explored individually, in models adjusted for sociodemographic as well as clinical variables. Results: In total, 3370 patients from 22 countries were included (mean (SD) age 43 (14) years; 66% male; 88% axial disease). Across countries, 1275 (38%) patients were bDMARD users. Crude mean bDMARD use varied between 5% (China) to 74% (Belgium). After adjustment for relevant sociodemographic and clinical variables, important variation in bDMARD use across countries remained (P<0.001). Country-level socioeconomic factors, specifically higher health expenditures, were related to higher bDMARD uptake, though not meeting statistical significance (OR 1.96; 95% CI 0.94 to 4.10). csDMARD uptake was significantly lower in countries with higher health expenditures (OR 0.32; 95% CI 0.15 to 0.65). Similar trends were seen with the other socioeconomic variables. Conclusions: There remains important residual variation across countries in bDMARD uptake of patients with SpA followed in specialised SpA centres. This is independent of well-known factors for bDMARD use such as clinical and country-level socioeconomic factors.
Keywords
ANKYLOSING-SPONDYLITIS, AXIAL SPONDYLOARTHRITIS, RHEUMATOID-ARTHRITIS, EUROPEAN COUNTRIES, RECOMMENDATIONS, ACCESS, VALIDATION

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MLA
Nikiphorou, Elena et al. “Inequity in Biological DMARD Prescription for Spondyloarthritis Across the Globe : Results from the ASAS-COMOSPA Study.” ANNALS OF THE RHEUMATIC DISEASES 77.3 (2018): 405–411. Print.
APA
Nikiphorou, E., van der Heijde, D., Norton, S., Landewe, R. B., Molto, A., Dougados, M., Van den Bosch, F., et al. (2018). Inequity in biological DMARD prescription for spondyloarthritis across the globe : results from the ASAS-COMOSPA study. ANNALS OF THE RHEUMATIC DISEASES, 77(3), 405–411.
Chicago author-date
Nikiphorou, Elena, Desiree van der Heijde, Sam Norton, Robert BM Landewe, Anna Molto, Maxime Dougados, Filip Van den Bosch, and Sofia Ramiro. 2018. “Inequity in Biological DMARD Prescription for Spondyloarthritis Across the Globe : Results from the ASAS-COMOSPA Study.” Annals of the Rheumatic Diseases 77 (3): 405–411.
Chicago author-date (all authors)
Nikiphorou, Elena, Desiree van der Heijde, Sam Norton, Robert BM Landewe, Anna Molto, Maxime Dougados, Filip Van den Bosch, and Sofia Ramiro. 2018. “Inequity in Biological DMARD Prescription for Spondyloarthritis Across the Globe : Results from the ASAS-COMOSPA Study.” Annals of the Rheumatic Diseases 77 (3): 405–411.
Vancouver
1.
Nikiphorou E, van der Heijde D, Norton S, Landewe RB, Molto A, Dougados M, et al. Inequity in biological DMARD prescription for spondyloarthritis across the globe : results from the ASAS-COMOSPA study. ANNALS OF THE RHEUMATIC DISEASES. 2018;77(3):405–11.
IEEE
[1]
E. Nikiphorou et al., “Inequity in biological DMARD prescription for spondyloarthritis across the globe : results from the ASAS-COMOSPA study,” ANNALS OF THE RHEUMATIC DISEASES, vol. 77, no. 3, pp. 405–411, 2018.
@article{8564294,
  abstract     = {Objectives: The value of biological disease-modifying antirheumatic drugs (bDMARDs) in spondyloarthritis (SpA) is well recognised, but global access to these treatments can be limited due to high costs and other factors. This study explores country variation in the use of bDMARDs in SpA in relation to country-level socioeconomic factors. 
Methods: Patients fulfilling the Assessment in SpondyloArthritis International Society (ASAS) SpA criteria in the multinational, cross-sectional ASAS Comorbidities in Spondyloarthritis study were studied. Current use of bDMARDs or conventional synthetic DMARDs (csDMARDs) was investigated in separate models, with multilevel logistic regression analysis, taking the country level into account. Contribution of socioeconomic factors, including country health expenditures, gross domestic product and human development index as independent country-level factors, was explored individually, in models adjusted for sociodemographic as well as clinical variables. 
Results: In total, 3370 patients from 22 countries were included (mean (SD) age 43 (14) years; 66% male; 88% axial disease). Across countries, 1275 (38%) patients were bDMARD users. Crude mean bDMARD use varied between 5% (China) to 74% (Belgium). After adjustment for relevant sociodemographic and clinical variables, important variation in bDMARD use across countries remained (P<0.001). Country-level socioeconomic factors, specifically higher health expenditures, were related to higher bDMARD uptake, though not meeting statistical significance (OR 1.96; 95% CI 0.94 to 4.10). csDMARD uptake was significantly lower in countries with higher health expenditures (OR 0.32; 95% CI 0.15 to 0.65). Similar trends were seen with the other socioeconomic variables. 
Conclusions: There remains important residual variation across countries in bDMARD uptake of patients with SpA followed in specialised SpA centres. This is independent of well-known factors for bDMARD use such as clinical and country-level socioeconomic factors.},
  author       = {Nikiphorou, Elena and van der Heijde, Desiree and Norton, Sam and Landewe, Robert BM and Molto, Anna and Dougados, Maxime and Van den Bosch, Filip and Ramiro, Sofia},
  issn         = {0003-4967},
  journal      = {ANNALS OF THE RHEUMATIC DISEASES},
  keywords     = {ANKYLOSING-SPONDYLITIS,AXIAL SPONDYLOARTHRITIS,RHEUMATOID-ARTHRITIS,EUROPEAN COUNTRIES,RECOMMENDATIONS,ACCESS,VALIDATION},
  language     = {eng},
  number       = {3},
  pages        = {405--411},
  title        = {Inequity in biological DMARD prescription for spondyloarthritis across the globe : results from the ASAS-COMOSPA study},
  url          = {http://dx.doi.org/10.1136/annrheumdis-2017-212457},
  volume       = {77},
  year         = {2018},
}

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