Can Distance Be a Limit of Access to Care in a Small Country Like Hungary? An Example for Photodynamic Therapy

Abstract

Purpose:: From 2000 to the end of 2005, the only approved treatment for reducing the risk of visual loss for patients with subfoveal choroideal neovascularisaton was verteporfin photodynamic therapy (PDT). In Hungary, there is one single provider for the treatment, situated in the capital, which is in a relative central position in this small country. The purpose of the study was to determine the factors influencing access to this standard-of-care treatment (PDT) in Hungary.

Methods:: Files of 727 patients treated with PDT in a 5 years period were reviewed to explore correlation between geographic home location and access to PDT treatment. Population by age groups of the 19 counties and the capital were compared to the number of PDT treatments performed on individuals living in the given area. PDT coverage (no. of patients treated / 10000 older inhabitants was correlated with the distance from the provider of the treatment.

Results:: Number of treatment/ 10000 inhabitants varied from 0,02 to 1,83 in the 20 regions of the country. AMD patients living in the capital seem to have 4 times more chance to gain access to PDT than others living elsewhere in the country. This ratio was about 2 for younger patients with CNV in pathologic myopia. Significant negative correlation was found between treatment coverage and distance from the provider (r= -0,75, p < 0.01). Half of the treatments were performed on patients living in the capital while only 17% of the population is living there. Using conservative estimate, 80% of the patients living outside the capital remained untreated.

Conclusions:: For elder patients, willingness to travel for a treatment and follow-up visits might be a problem even in a small country like Hungary. This fact may be of importance when new treatments for AMD are introduced.

Keywords: age-related macular degeneration • photodynamic therapy