Michelsen, BrigitteBrigitteMichelsenØstergaard, MikkelMikkelØstergaardNissen, Michael JohnMichael JohnNissenCiurea, AdrianAdrianCiureaMöller, BurkhardBurkhardMöller0000-0001-8769-6167Midtbøll Ørnbjerg, LykkeLykkeMidtbøll ØrnbjergHorák, PavelPavelHorákGlintborg, BenteBenteGlintborgMacDonald, AlanAlanMacDonaldLaas, KarinKarinLaasSokka-Isler, TuulikkiTuulikkiSokka-IslerGudbjornsson, BjornBjornGudbjornssonIannone, FlorenzoFlorenzoIannoneHellamand, PasoonPasoonHellamandKvien, Tore KristianTore KristianKvienRodrigues, Ana MariaAna MariaRodriguesCodreanu, CatalinCatalinCodreanuRotar, ZigaZigaRotarCastrejón, IsabelIsabelCastrejónWallman, Johan KarlssonJohan KarlssonWallmanPavelka, KarelKarelPavelkaLoft, Anne GitteAnne GitteLoftHeddle, MaureenMaureenHeddleVorobjov, SigridSigridVorobjovRelas, HeikkiHeikkiRelasGröndal, GerdurGerdurGröndalGremese, ElisaElisaGremesevan der Horst-Bruinsma, IreneIrenevan der Horst-BruinsmaKristianslund, Eirik KlamiEirik KlamiKristianslundSantos, Maria JoséMaria JoséSantosMogosan, CorinaCorinaMogosanTomsic, MatijaMatijaTomsicDiaz-Gonzalez, FedericoFedericoDiaz-GonzalezGiuseppe, Daniela DiDaniela DiGiuseppeNielsen, Stig WintherStig WintherNielsenHetland, Merete LundMerete LundHetland2025-05-062025-05-062025-06https://boris-portal.unibe.ch/handle/20.500.12422/210128Background Studies on national policies for biologics are warranted.Objectives To map and compare national healthcare set-ups for prescription, start, switch, tapering, and discontinuation of biologic/targeted synthetic disease-modifying antirheumatic drugs (DMARDs) in patients with psoriatic arthritis and axial spondyloarthritis across Europe, and assess the healthcare set-ups in relation to countries' socio-economic status.Methods An electronic survey was developed to collect and compare information on national healthcare systems. The relationship between the cumulative score of biologic/targeted synthetic DMARD regulations, socioeconomic indices, and biologic originator costs were assessed by linear regression.Results National healthcare set-ups differed considerably across the 15 countries, with significantly fewer regulations with increasing socioeconomic status measured by GDP/current health expenditure/human development index, and with increasing biologic originator costs. In most countries, the biologic/targeted synthetic DMARD prescribing doctor was required to adhere to country and/or hospital recommendations, and about a third of countries had a national/regional tender process. Prescription regulations for biologic/targeted synthetic DMARDs, including pre-treatment and disease activity requirements, varied substantially. Approximately a third of countries had criteria for discontinuation and tapering, whereas only few had for switching. Notably, two countries disallowed biologic/targeted synthetic DMARD retrials, and one imposed limit on the maximum number of biologic/targeted synthetic DMARDs permitted.Conclusion The findings highlight substantial variability in healthcare set-ups for biologic/targeted synthetic DMARD use in psoriatic arthritis and axial spondyloarthritis across Europe and their association with socioeconomic status and drug costs. These insights provide a basis for rheumatology societies, policymakers, and stakeholders to evaluate and potentially optimize healthcare policies.enAccess to health careAxial spondyloarthritisBiologic therapyHealth policyPsoriatic arthritisSocioeconomic health disparities600 - Technology::610 - Medicine & healtharticle10.48620/878354024567510.1016/j.healthpol.2025.105311