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Abstract
Introduction Idiopathic Pulmonary Fibrosis (IPF) is a progressive, fatal disease. The antifibrotic drugs (AFDs) pirfenidone and nintedanib are licensed treatments but are only available at specialised centres. We have previously shown that patients whose local hospital was a prescribing centre (PC) were more likely to be receiving AFDs than those whose local hospital was not a prescribing centre (NPC).1
Objectives We set out to test the hypothesis that this indicates differences in ability to travel or to seek specialist care which might be reflected in differences in indices of multiple deprivation (IMD).
Methods We obtained a full list of patients who received AFDs since 2013 and obtained their postcodes from hospital databases. We additionally obtained markers of socio-economic status based on the IMD score obtained from government websites. Data were recorded in January 2016 and July 2017 and compared with non-parametric statistics.
Results The number of patients per 1 00 000 population in each postcode area started on AFDs increased from a median (range) of 3.04 (0–15.86) in 2016 to 8.81 (1.16–33.87) in 2017 (p=4x10-6). In both 2016 (p=0.0119) and 2017 (p=0.0089), there were more patients on AFDs per postcode area where the local hospital was a PC compared to a NPC. Looking at the distribution of IMD in 2017, there was a small difference (p=0.057) that did not appear fully to explain the difference in AFD prescriptions between PC and NPC.
Conclusions The NHS constitution requires equality in access to therapy regardless of where the patient lives. Although AFD prescriptions have increased significantly between 2016 and 2017, we have again demonstrated inequality of access to AFDs depending on patient location. These differences do not appear fully explained by differences in indices of multiple deprivation.
Refernce 1. Woodhead FA, Townsend S, Desai D. P171 Health inequality exists in pirfenidone prescription for idiopathic pulmonary fibrosis in the English Midlands according to patient location. Thorax 2016, Dec 1;71(3):A176–7.