Abstract / Summary
Systemic sclerosis (SSc) is a rare, multiorgan disease in adults that requires specialized care. Commuting to tertiary medical centers poses a considerable burden and incurs significant costs, potentially affecting management choices. This study aims to describe the healthcare commuting burden and evaluate whether longer commuting distances are associated with disease severity and differences in medication access among Italian SSc patients. The driving distance from the city of residence to the care center was calculated using the Google Maps Distance Matrix API for patients from the Systemic Sclerosis Progression Investigation (SPRING) registry. These distances were categorized according to EUROSTAT classes. Travel distance was then correlated with clinical variables, medication access, and estimated annual pharmaceutical costs, based on standard doses and fares from the Italian Medicines Agency. The median commuting distance of the 1,795 enrolled patients was 59.4 (IQR 38.2–101.9) km, with 25.7% of them traveling more than 100 km to reach the tertiary center. Patients commuting more than 100 km to reach a tertiary center presented more frequent and severe vascular and fibrotic pulmonary complications and more commonly accessed advanced medications. The median annual drug cost was €4,407/patient, with 6.2% of patients accounting for half of the total medication budget. Drug costs reflect clinical manifestations, but correlated with commuting distances independently of disease severity. Commuting distances are correlated with disease severity and the need for advanced treatments. Public health strategies should aim to enhance accessibility to specialized care and advanced therapies for these patients, recognizing the impact of travel burden on healthcare access.