Get clarity on relative access to medication

Medicines are an essential part of the cure or management of many illnesses. When administered well, they can play an important role in achieving high quality of life for patients. But are medicines available to everyone, everywhere, equally? 

Jump to the downloads

To answer this question, LOGEX and The Dutch Institute of Rational Use of Medicine (IVM) developed International Medicines Uptake Comparator in 2021. It is a medicines uptake measurement metric based on a unique methodology which uses open-source, real-world data. It aims to provide objective clarity on medicines uptake levels comparing different countries. 

The methodology was first used for the International Comparison Medicines Uptake 2021 report, that LOGEX and IVM created for NHS England & NHS Improvement. Now, LOGEX, with financial sponsorhip of AstraZeneca, is presenting the second report using this methodology: International Comparison Biologics Uptake 2023 – Severe Asthma. LOGEX again commissioned IVM to support them with the data collection and analyses of this report.

In International Comparison Biologics Uptake 2023 – Severe Asthma, the uptake of biologics for the treatment of severe asthma is analysed, calculated and compared between 10 European healthcare markets (Belgium, Denmark, England, Finland, France, Germany, Italy, the Netherlands, Norway and Sweden). We’ve combined data on uptake with market insights on indication splits, which allowed us to provide a more detailed analysis of the use of biologics for severe asthma. The report consists of two parts. Besides the primary section in which open-source real-world data are taken into account, the report also contains a second section in which information drawn from interviews with experts is taken into consideration in the uptake conclusions. The report shows important differences in the uptake of biologics in severe asthma across countries. More specifically, the UK and Finland are substantially lagging in uptake compared to the other countries.

The goal of the report is to empower decision-making to optimise access to medication and making the best possible care accessible and more affordable for everyone.

The report has been sponsored through funding by Astra-Zeneca. AstraZeneca had no input or editorial control over the final content of the report. AstraZeneca, alongwith  other industry experts, were approached for medicine indication split estimates for use within LOGEX’s calculations in Part B of the report, which was reactively provided with no compulsion to use these data.

International Comparison Biologics Uptake 2023 Executive Summary

To this day, asthma remains a chronic disease, affecting in excess of 262 million people globally in 2019 ¹. Being a common disease, asthma has a substantial impact on individuals and healthcare services. Severe asthma, which has many definitions, can be thought of as one extreme end in the spectrum of the disease. Despite severe asthma being estimated to make up only 5 percent of overall asthma burden, it accounts for 50 percent of the economic expenditure of asthma ².

In asthma the overuse of short-acting beta agonists (SABAs) is a common occurrence and can signify undertreatment with maintenance therapies ³. In severe asthma, chronic use of oral corticosteroid is similarly widespread, with one UK study citing 51 percent of severe asthma patients being on maintenance oral corticosteroid treatment ⁴. Patients often suffer from frequent and distressing hospital attendances due to high exacerbation rates. Mortality rates are high. More recently, novel treatments in the form of biologics have entered the market and have shown efficacy for severe asthma management. A recent systematic review demonstrated that biologics can reduce severe asthma exacerbations by 51 percent ⁵. This is further backed by patients surveyed in 2020 by Asthma and Lung UK, they found that 64 percent of severe asthma patients on biologics experienced reduced symptoms and 43 percent of these patients experienced reduced hospital admissions ⁶. Additionally a recent ABPI publication highlighted that increased uptake of biologics in severe asthma could lead to an increase in the quality of life for patients (measured in QALYs) and a productivity boost of ￡9.6 billion to the UK economy ⁷. Although prescribing is shifting from oral corticosteroids to biologics, wide variations across countries exist in terms of the speed and scale of this shift.

The disproportionate economic cost and burden of severe asthma in relation to asthma, and the shift in usage of biologics makes understanding the changing picture of biologics uptake even more important. This provides a significant opportunity for LOGEX, with financial sponsorship of AstraZeneca, to deliver tangible insights on the extent to which biologics are being used in different European countries. IVM (Instituut Verantwoord Medicijngebruik) supported LOGEX in data collection and analysis.

A previous 2021 report – International Comparison Medicines Uptake was developed for NHS (National Health Service) England and focussed on five high health gain areas of importance for England. It delivered a standard, repeatable, and scalable methodology to carry out robust international comparisons on the uptake of medicines, using publicly available data sources. In this follow-up 2023 report, we deliver an in-depth report of uptake patterns of biologics among patients with severe asthma in European countries, based on that same methodology. As most included countries were already assessed in the first report for the NHS, the current report provides a measure of the increase in the uptake of biologics in all countries. Furthermore, in this report, the relatively new biologic drug dupilumab, has also been taken into account.

We believe an uptake tracking measurement provides a unique and important window of insight, as the measurement can be used to study how countries adhere to the international treatment guidelines. It also provides the opportunity to evaluate the effects of access policies and reimbursement decisions for patients. All countries, regardless of rank, can still improve their services for asthma patients.

Biologics have a complex set of prescription criteria in severe asthma affecting reimbursement and this varies across countries and continents ⁷. Currently, it is unclear how many patients with severe asthma are eligible for biologics, nor it is known how many patients are able to be reimbursed. This report demonstrates that countries across Europe have varying uptake of asthma biologics ranging from as low as 5% to as high as 60%. Germany has a relatively high biologics uptake in the severe asthma population, while the biologics uptake for severe asthma in England and Finland is lagging behind substantially compared to the other countries. Notably these countries demonstrate that where uptake is high or low, so too is the change over time; Germany and Sweden show a higher relative increase in uptake between 2019 and 2021 for the severe asthma population, whilst England and Finland do not.

1. Global Burden of Disease Collaborative Network. Global Burden of Disease Study 2019 (GBD 2019) Results. Seattle. http://ghdx.healthdata.org/gbd-resultstool. [Online]
2. Current and emerging treatments for severe asthma. Al Efraij K, FitzGerald JM. s.l. : J Thorac Dis. 2015 , Nov;7(11):E522-5. . doi: 10.3978/j.issn.2072-1439.2015.10.73. PMID: 26716048; PMCID: PMC4669299.
3. Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: a nationwide cohort study of the global SABINA programme. Nwaru BI, Ekström M, Hasvold P, Wiklund F, Telg G, Janson C. Vol. Eur Respir J. 2020 Apr 16;55(4):1901872. doi: 10.1183/13993003.01872-2019. PMID: 31949111; PMCID: PMC7160635..
4. Characterisation of patients with severe asthma in the UK Severe Asthma Registry in the biologic era. Jackson DJ, Busby J, Pfeffer PE, Menzies-Gow A, Brown T, Gore R, Doherty M, Mansur AH, Message S, Niven R, Patel M, Heaney LG and Registry., UK Severe Asthma. Mar;76(3):220-227. doi: 10.1136/thoraxjnl-2020-215168., s.l. : Thorax, 2021, Respiratory Medicine, pp. 52-62. PMID: 33298582; PMCID: PMC7892381..
5. Efficacy and safety of treatment with dupilumab for severe asthma: A systematic review of the EAACI guidelines-Recommendations on the use of biologicals in severe asthma. . Agache I, Song Y, Rocha C, Beltran J, Posso M, Steiner C, Alonso-Coello P, Akdis C, Akdis M, Canonica GW, Casale T, Chivato T, Corren J, Del Giacco S, Eiwegger T, Firinu D, Gern JE, Hamelmann E, Hanania N, Mäkelä M, Martín IH, Nair P, O’Mahony L, Papadopo. s.l. : Allergy. , 2020, Vols. 75(5):1058-1068. . doi: 10.1111/all.14268. Epub 2020 Apr 1. PMID: 32154939..
6. Asthma&Lung. Do no harm: safer and better treatment options for people with asthma. UK : The Asthma UK and British Lung Foundation Partnership, 2020.
7. ABPI, PwC. PWC – Transforming Lives, raising productivity. [Online] 05 22, 2022. [Cited: 05 30, 2023.] https://www.abpi.org.uk/publications/