Longer travel to systemic sclerosis centers linked to severity and medication access

An observational geographical study using Italy’s Systemic Sclerosis Progression Investigation (SPRING) registry examined associations between travel to tertiary care, disease severity, and medication access in 1,795 patients with systemic sclerosis. Researchers calculated driving distances from patients’ cities of residence to their care centers using Google Maps and estimated annual pharmaceutical costs using standard doses and Italian Medicines Agency prices.

The median commuting distance was 59.4 km (IQR 38.2–101.9), and 25.7% of patients traveled more than 100 km. Those traveling more than 100 km had more frequent and severe vascular and fibrotic pulmonary complications and more commonly accessed advanced medications. Median estimated annual drug costs were €4,407 per patient; 6.2% of patients accounted for half the total medication budget. Drug costs were associated with clinical manifestations and correlated with travel distance independently of disease severity.

The findings highlight travel burden as a consideration in access to specialist systemic sclerosis care. However, these observational associations do not establish whether travel distance affects disease severity or treatment access. Distances were calculated from cities of residence, and pharmaceutical costs were estimates rather than measures of patients’ travel expenses. The authors call for strategies to improve access to specialized care and advanced therapies.