EQUITY BY DESIGN: A NATIONWIDE GEOSPATIAL ASSESSMENT OF BRAZIL'S CAPACITY TO DELIVER INTRAVENOUS ALS THERAPIES
Author(s)
Ana Luiza Guerra, BSc1, Bruna Contieri, BSc, MSc2, Rafaela Guardia, BSc3, Zimbo Sebastião, BSc1, Matheus Costa e Silva, BSc1, SARAH R. RODRIGUES, BSc, MSc3.
1Evidence Generation, Daiichi Sankyo, São Paulo, Brazil, 2Daiichi Sankyo, São Paulo, Brazil, 3Market Access, Daiichi Sankyo, São Paulo, Brazil.
1Evidence Generation, Daiichi Sankyo, São Paulo, Brazil, 2Daiichi Sankyo, São Paulo, Brazil, 3Market Access, Daiichi Sankyo, São Paulo, Brazil.
OBJECTIVES: Amyotrophic lateral sclerosis (ALS) is a rare progressive disease characterized by motor neuron degeneration, with a median survival of 3-5 years. Riluzole has been the standard therapy in the Brazilian Unified Health System (UHS) for over two decades. In this context, new therapies offer an additional therapeutic option for a rare and high-burden condition. This study evaluates UHS readiness by analyzing infusion capacity and geographic access across all 5,578 Brazilian municipalities, informing equitable implementation of IV therapies.
METHODS: We conducted a nationwide retrospective analysis integrating administrative outpatient records (SIASUS-AM), healthcare facility data (CNES), and municipal geospatial information (IBGE) from public Brazilian databases. Patients were identified through patients registered under active treatment ICD-10 G12.2 as a proxy for ALS. Resourcing-supply linkage was based on treatment records and UHS facilities capable of intravenous infusion. Centroid-to-centroid distance matrices were used to estimate geographic access, identify municipalities lacking local infusion capacity, and determine the nearest infusion-capable facility.
RESULTS: This is the first study to assess equitable access to IV therapies for ALS within the Brazilian UHS, one of the world’s largest public healthcare systems. Of 5,578 municipalities, 1,770 had ALS patients, of which 1,452(82%) had infusion centers. Among 6,667 ALS patients, 93.8% had access within their municipality, while 6.2% required travel. The mean distance to an infusion center was 4.4 km, suggesting feasible access for most patients, whereas those traveling faced a mean distance of 24.7 km.
CONCLUSIONS: The analysis demonstrated that most ALS patients potentially eligible for intravenous treatment would have feasible geographic access to existing infusion infrastructure in Brazil. The findings suggest that the available network can support therapy implementation without substantial capacity expansion, providing evidence to inform healthcare planning and access strategies within the Brazilian public health system.
METHODS: We conducted a nationwide retrospective analysis integrating administrative outpatient records (SIASUS-AM), healthcare facility data (CNES), and municipal geospatial information (IBGE) from public Brazilian databases. Patients were identified through patients registered under active treatment ICD-10 G12.2 as a proxy for ALS. Resourcing-supply linkage was based on treatment records and UHS facilities capable of intravenous infusion. Centroid-to-centroid distance matrices were used to estimate geographic access, identify municipalities lacking local infusion capacity, and determine the nearest infusion-capable facility.
RESULTS: This is the first study to assess equitable access to IV therapies for ALS within the Brazilian UHS, one of the world’s largest public healthcare systems. Of 5,578 municipalities, 1,770 had ALS patients, of which 1,452(82%) had infusion centers. Among 6,667 ALS patients, 93.8% had access within their municipality, while 6.2% required travel. The mean distance to an infusion center was 4.4 km, suggesting feasible access for most patients, whereas those traveling faced a mean distance of 24.7 km.
CONCLUSIONS: The analysis demonstrated that most ALS patients potentially eligible for intravenous treatment would have feasible geographic access to existing infusion infrastructure in Brazil. The findings suggest that the available network can support therapy implementation without substantial capacity expansion, providing evidence to inform healthcare planning and access strategies within the Brazilian public health system.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
RWD106
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Neurological Disorders, No Additional Disease & Conditions/Specialized Treatment Areas, Rare & Orphan Diseases