Rheumatoid Arthritis Disease Burden and Access to Treatment

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1 Berlin, April 2012 Rheumatoid Arthritis Disease Burden and Access to Treatment Gisela Kobelt, PhD Visiting Professor, Lund University (Sweden) President, European Health Economics (France)

2 Disclaimers This presentation uses data from a report produced for the EFPIA Kobelt G and Kasteng F. The burden of RA and access to innovative treatments published literature and economic data All work is fully independent and no conflict of interest is declared I have however performed economic studies and been a consultant to all pharmaceutical companies marketing new RA treatments 2

3 Health and Economic Burden Onset generally Productive population (~50%) Inflammation, pain, fatigue Short term disability, dependence Functional handicap Permanent disability, dependence Comorbidities Premature mortality Mental component Fear, anxiety, depression, isolation Negative impact on - quality of life, - activities (daily life, professional), - consumption 3

4 Burden Mean Annual Costs of RA in Europe Societal viewpoint, all costs regardless to whom they occur Mean annual cost per Patient 15,000 in Western Europe (2008) Production loss 33% Direct medical cost 31% Biologics 9% Informal care 16% Direct non-medical cost 11% 4

5 Burden Cost and Disease Progression Mean annual cost per patient by disease severity in France ( 2005) 45,000 40,000 35,000 30,000 25,000 20,000 15,000 Production losses Patient costs/informal care Health care costs 10,000 5,000 0 < < < < <2.5 >=2.5 Disease severity (Fúnction, HAQ) Source: Kobelt et al, JBS 2008; Kobelt et al, JNNP 2006) 5

6 % of patients <60 years working Burden Impact on Work Capacity Proportion of patients below 60 years in the workforce (France 2005) 80% 70% 60% Normal workforce participation between % 40% 30% 20% 10% 0% < < < < <2.5 >=2.5 Grouping by functional capacity (HAQ) Source: Kobelt

7 Burden Impact on Quality of Life (Utility) Disease Mean utility N Other rheumatoid arthritis Rheumatoid arthritis Multiple sclerosis Angina pectoris Acute myocardial infarction Atrial fibrillation and flutter Chronic ischaemic heart disease Gastro-oesophageal reflux disease Crohn's disease (regional enteritis) Essential (primary) hyptertension Malignant neoplasm of prostate Non-insulin-dependent diabetes Ulcerative colitis Source: Adapted from Curry et al, ViH

8 Utility Burden Quality of Life and Disease Progression < < < < <2.5 >=2.5 HAQ (function) Normal population (Women age 50-70) France Sweden Source: Kobelt 2005, Kobelt

9 Uptake of Biologic Treatments Proportion of RA Patients Treated (W.Europe 2008) Proportion of Patients on Biologic Treatment (W.Europe) Norway Belgium Ireland Denmark Spain Sweden Greece Switzerland Finland France Netherlands E13 United Kingdom Germany Italy Estimated from mg sold and annual doses required Portugal 0% 5% 10% 15% 20% 25% 30% 9

10 Uptake of Biologic Treatments Proportion of RA Patients Treated (C/E.Europe 2008) Proportion of Patients on Biologic Treatment (CE.Europe) E13 Czech republic Germany Slovenia Hungary Slovakia Estonia Lithuania Latvia Romania Poland Bulgaria Estimated from mg sold and annual doses required 0% 2% 4% 6% 8% 10% 12% 10

11 Interlinked Uptake of Biologic Treatments Hindrance to Uptake Cost Clinical guidelines Requirements for high disease activity, line of treatment, evaluation time E.g. UK, Italy, Czech Republic Budgetary constraints Limitations per practice, caps on total expenditures E.g. UK, Italy, in part Germany Access to rheumatologists Limitation of authorized prescribers E.g. Italy, Central/Eastern European countries Lack of professionals E.g. Germany, Italy 11

12 Number of RA Patients per Rheumatologist (Eurostat ) Number of RA patients per rheumatologist Austria Belgium Bulgaria Cyprus Czech Republic Denmark Estonia Finland France Germany Greece Hungary Iceland Ireland Italy Latvia Lithuania Luxembourg Malta Netherlands Norw ay Poland Portugal Romania Slovakia Slovenia Spain Sw eden Sw itzerland United Kingdom Turkey

13 Density of Rheumatologist Lögd NRW, Erlangen

14 % of physicians Initiation of Biologic Treatments Guidelines, Time to Treatment, Access to Rheumatologists? No. of Trad. DMARDs normally tried before initiating a biologic DMARD (Etanercept/ Adalimumab/ Infliximab): 100% 80% 5% 16% 3% 5% 31% 15% 11% 4% 11% 25% Trad. DMARD prescription not important Failed on 3+ 60% 66% 56% Failed on 2 62% 52% 40% 68% 69% Failed on 1 20% 0% 26% 28% 20% 16% 1% 1% 5% EU (307) France (65) Germany (65) Italy (65) Spain (57) UK (55) 0 Source: Miltenburger

15 Conclusions Access to treatment is highly variable in Europe due to economic differences organizational issues Time to rheumatologist (availability, restrictions) Time to treatment (guidelines, prescribers) Benefits of biologics (for the right patients) not in question price and total expenditures an issue Identification of patients in highest need (bad prognosis) key 15

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