Efficiency and equity in radiotherapy accessibility and availability in France

Area of Science:

• Oncology
• Public Health
• Health Services Research

Background:

• Radiotherapy access in France is primarily covered by national health insurance.
• Geographic location and socioeconomic factors can influence disparities in radiotherapy access.
• Variations in travel time, treatment availability (e.g., brachytherapy), and resource density contribute to access inequities.

Purpose of the Study:

• To assess the accessibility and availability of radiotherapy across metropolitan France and overseas departments.
• To identify potential inequities in radiotherapy access based on geographic location and regional income.

Main Methods:

• Utilized commune-level data for geographic analysis across France.
• Calculated travel times via road and public transport to radiotherapy units.
• Defined accessibility based on travel time thresholds for different radiotherapy modalities (EBRT, SBRT, brachytherapy).
• Assessed availability using population-weighted efficiency and equity metrics.

Main Results:

• 90% of the population had access to a radiotherapy unit within 45 minutes by road.
• 40% had access via public transport within 45 minutes.
• 40% had access to all radiotherapy treatment modalities, excluding head and neck brachytherapy.
• Residents in mountainous and less populated areas experienced longer travel times.
• Resource availability within units was independent of travel time, population density, and income, but non-dense areas with higher incomes had better access.

Conclusions:

• Radiotherapy access in France is generally good and equitable, but persistent disparities exist.
• Factors like territorial density, mountainous terrain, and real estate market may influence these disparities.
• Densely populated areas demonstrate the highest and most equitable radiotherapy accessibility.