P257 Are there regional variations in access to biological disease modifying anti-rheumatic drugs for the treatment of psoriatic arthritis in England?

Abstract

Abstract Background/Aims There are regional variations in access to biologic disease modifying anti-rheumatic drugs (bDMARDs) for patients with rheumatoid arthritis in the UK, with relative under-treatment according to established best practice. Similar concerns exist for access to biologic therapies for patients with psoriatic arthritis (PsA). In this study we set out to understand regional variations in access to bDMARDS for the treatment of PsA in England. Methods Formularies are mandated to be published by the National Institute for Health and Care Excellence (NICE). ValueBase, a personalised business intelligence company specialising in healthcare, tracks every change for every drug on every published formulary every day with data from January 2017 in 184 formularies. The Availability Index (AI) is used to standardise individual formulary listing differences. It is scored from 0-100 and calculated by dividing the ‘base score’ for prescribing initiators by the ‘prescribing position’. The ‘base score’ values included 0 (not recommended), 5 (unlisted/under review), 30 (restricted availability), 45 (specialist/hospital only), 65 (initiated by specialist, continued in primary care) and 100 (all prescribers). We would expect the optimal score to be > 45 as these are specialist medications. The ‘prescribing position’ included where the drug is ranked on the formulary (e.g., first line). Results For anti-TNFa, the mean AI was 45 ([standard deviation] SD 16, minimum 0, maximum 100). For the IL-17 inhibitors, the mean AI was 48 (SD 17, the minimum 0, maximum 100). For the IL-23 inhibitors, the mean AI was 48 (SD 18, minimum 30, maximum 100). For the JAK inhibitors, the mean AI was 24 (SD 22, minimum 0, maximum AI 50). For the other monoclonal antibodies, the mean AI was 45 (SD 14, minimum 0, maximum 100). The rate of formulary adoption for new drugs approved since 2016 varied considerably (Table 1). Conclusion There are regional variations in access to bDMARDs for treatment of PsA in England. Such differences have also been demonstrated in other countries (e.g., Sweden) and call for further improvement towards delivering equitable PsA care, both nationally and internationally. Disclosure A. Vivekanantham: None. L. Coates: None. W. Tillett: Consultancies; WRT has received research funding, consulting, or speaker fees from Abbvie, Amgen, Celgene, Eli Lilly, Janssen, MSD, Novartis, Pfizer and UCB.