Gaps in Access to Diagnostic Studies and Treatments for Patients with Lymphoproliferative Diseases in Chile

Introduction: Chile is a country in Latin America that is classified as high-income by the World Bank Group. However, there are significant wage differences, with half of the country's population concentrated in the lowest income brackets (Fonasa A and B) of the public welfare system, which has coverage for approximately 80% of the population. Additionally, geographical characteristics can lead to the concentration of specialized services in large cities. For these reasons, the study aims to determine the gaps in access to diagnostic studies and treatment for patients with lymphoproliferative diseases in Chile.

Methods: We conducted a cross-sectional study by sending a survey to hematologists in Chile between October and December 2023. The survey included questions about the type of work activity (public or private) and the characteristics of health centers. It consisted of 9 questions related to access to diagnostic studies, staging, and treatment response, and 30 items on access to treatment. We used a 5-point Likert scale (1= never, 2= rarely, 3= sometimes, 4= almost always, 5= always) and dichotomized the answers into low access (1-3) and greater access (4 and 5). Consistency was evaluated using Cronbach's alpha, with values between 0.7 and 0.9 considered optimal. Single and multiple logistic regression analyses were performed, considering the location and type of health center as explanatory variables. Statistical analysis was conducted using the glm function and the psych library in R software.

Results: The survey was answered by 47 hematologists from 14 out of 16 regions, providing information from 59 centers (68% public and 32% private), of which 34% were located in the Metropolitan Region. In the crude models, we found significantly greater access in the Metropolitan Region to PET-CT, tissue flow cytometry, and new drugs compared to other regions. We determined that access in the public system (adjusted for the location of the center) was significantly lower than in the private system for PET-CT at diagnosis (OR 0.12; 95% CI 0.02, 0.52) and interim (OR 0.17; 95% CI 0.02, 0.71). Additionally, we evidenced a 94% and 90% reduction in the chance of access to nivolumab/pembrolizumab (p=0.001) and brentuximab (p=0.001), respectively, in the second line of treatment for patients with Hodgkin's lymphoma, as well as for Bruton's tyrosine kinase inhibitors for patients with chronic lymphocytic leukemia (OR 0.06, p<0.001). The results regarding access to specific treatments for patients with follicular, mantle, and T-cell aggressive lymphomas were similar.

Conclusions: We demonstrate reduced access to diagnostic studies and specific treatments in health centers outside the Metropolitan Region and public hospitals. Identifying these gaps can contribute to developing public policies that reduce these disparities, resulting in better health outcomes.

No relevant conflicts of interest to declare.