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International guidelines on access to biologic therapy: why the differences and which is best?

Nature Clinical Practice Rheumatology volume 4, pages 520–521 (2008)Cite this article

Biologic therapies have had a profound effect on the treatment of patients with inflammatory arthritis; however, their cost has elevated rheumatology from an often ignored discipline into one that demands the attention of health economy fund holders and policy makers. Guidelines try to ensure appropriate access to biologic therapies but vary considerably between different nations; for example, in some parts of the western world, patients are denied access to therapies that would be available in other countries (sometimes geographic neighbors). Why are there such marked differences in the guidelines for availability of such agents, what can we learn from these discrepancies, and which guidelines are best?

Let us take the example of international guidelines for anti-tumor necrosis factor (TNF) therapy for patients with rheumatoid arthritis (RA). Most guidelines are a combination of evidence and expert opinion, and might incorporate some consideration of cost implications; however, few undergo rigorous economic modeling. The variation in access to biologics in different countries, and even within countries, relates in part to the nature of drug reimbursement programs. For example, in the UK, the National Institute for Health and Clinical Excellence (NICE) sets guidelines that are applied uniformly across the universal-access National Health Service.1 By contrast, some countries with both private and state-funded health care might have differential access depending on prescription coverage (e.g. the US and Canada).

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Author information

Authors and Affiliations

  1. C Deighton is a Consultant Rheumatologist and Special Lecturer at the Derbyshire Royal Infirmary, Derby, UK.,

    Chris Deighton

  2. K Hyrich is a Senior Lecturer in Rheumatic Disease Epidemiology at the ARC Epidemiology Unit, University of Manchester and a Consultant Rheumatologist at the Manchester Royal Infirmary, Manchester, UK.,

    Kimme Hyrich

Authors
  1. Chris Deighton
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Corresponding author

Correspondence to Chris Deighton.

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Competing interests

C Deighton works at the Department of Rheumatology at Derbyshire Royal Infirmary, which has received sponsorship from Abbott, Schering–Plough Pharmaceuticals and Wyeth for support of clinical meetings, and unrestricted grants from Schering–Plough and Wyeth to support an anti-tumor necrosis factor audit clerk and research nurse. C Deighton has also previously sat on an advisory board for Schering–Plough and received honoraria for talks at symposia sponsored by Abbott and Wyeth. K Hyrich declared no competing interests.

Supplementary information

Supplementary information

Examples of international guidelines on the use of anti-tumor necrosis factor therapy in patients with rheumatoid arthritis. (DOC 32 kb)

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Deighton, C., Hyrich, K. International guidelines on access to biologic therapy: why the differences and which is best?. Nat Rev Rheumatol 4, 520–521 (2008). https://doi.org/10.1038/ncprheum0877

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