BACKGROUND: 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.

3rd Department of Internal Medicine Nephrology Rheumatology and Endocrinology Faculty of Medicine and Dentistry Palacky University Olomouc Czech Republic; Olomouc University Hospital Olomouc Czech Republic

Aberdeen Centre for Arthritis and Musculoskeletal Health University of Aberdeen UK

Center for Rheumatic Diseases University of Medicine and Pharmacy Bucharest Romania

Center for Treatment of Rheumatic and Musculoskeletal Diseases Diakonhjemmet Hospital Oslo Norway

Centre for Rheumatology Research Landspitali University Hospital Reykjavik Iceland

Centre for Rheumatology Research Landspitali University Hospital Reykjavik Iceland; Faculty of Medicine University of Iceland Reykjavik Iceland

Clinical Epidemiology Division Department of Medicine Solna Karolinska Institutet Stockholm Sweden

Clinical Immunology Unit Fondazione Policlinico Universitario A Gemelli IRCCS Università Cattolica del Sacro Cuore Roma Italy

Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark

Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark; Department of Clinical Medicine University of Copenhagen Copenhagen Denmark

Copenhagen Center for Arthritis Research Diakonhjemmet Hospital Oslo Norway

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark; DANBIO and Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark

Department of Clinical Sciences Lund Rheumatology Skåne University Hospital Lund University Lund Sweden

Department of Rheumatology Aarhus University Hospital Aarhus Denmark; Department of Clinical Medicine Aarhus University Aarhus Denmark

Department of Rheumatology and Clinical Immunology Amsterdam University Medical Centers Amsterdam Netherlands; Amsterdam Rheumatology Immunology Center Reade and Amsterdam UMC Amsterdam Netherlands

Department of Rheumatology and Immunology Inselspital University Hospital Bern Switzerland

Department of Rheumatology East Tallinn Central Hospital Tallinn Estonia

Department of Rheumatology Geneva University Hospital Geneva Switzerland

Department of Rheumatology Hospital Garcia de Orta Almada Portugal; Instituto Medicina Molecular Faculdade de Medicina da Universidade de Lisboa Portugal

Department of Rheumatology Hospital General Universitario Gregorio Marañón Madrid Spain; Faculty of Medicine Complutense University of Madrid Spain

Department of Rheumatology Hospital Universitario de Canarias Universidad de La Laguna Spain; Department of Internal Medicine Dermatology and Psychiatry Universidad de La Laguna Spain

Department of Rheumatology University Hospital Zurich University of Zurich Zurich Switzerland

Department of Rheumatology University Medical Centre Ljubljana Ljubljana Slovenia; Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Institute of Rheumatology Prague Czech Republic; Department of Rheumatology 1st Faculty of Medicine Charles University Prague Czech Republic

National Institute for Health Development Tallinn Estonia

NHS Grampian Scotland UK

Patient research partner Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Centre for Head and Orthopaedics Rigshospitalet Glostrup Denmark

Radboud University Medical Centre Nijmegen the Netherlands

Reuma pt Sociedade Portuguesa de Reumatologia Lisbon Portugal; EpiDoC unit CHRC Nova Medical School Lisbon Portugal; Rheumatology Unit Hospital dos Lusíadas Lisbon Portugal

Rheumatology Inflammation Center Helsinki University Hospital Helsinki Finland; University of Helsinki Helsinki Finland

Rheumatology Unit DiMePRe J University of Bari Italy

University of Eastern Finland Faculty of Health Sciences and Rheumatology Jyvaskyla Central Hospital Jyvaskyla Finland

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