Acceso a terapias antifibróticas en Chile ¿Protección financiera para cubrir una brecha de tratamiento en fibrosis pulmonar idiopática y fibrosis pulmonar progresiva?

Abstract

Introduction: Idiopathic pulmonary fibrosis and progressive pulmonary fibrosis are fibrosing in- terstitial lung diseases with high morbidity and mortality. Antifibrotic therapies have demonstrated the ability to modify the natural course of these diseases; however, in Chile they lack guaranteed coverage. Objective: To estimate the disease burden of fibrosing interstitial lung diseases (ILD) in Chile and quantify the access gap to antifibrotic therapies. Methods: Narrative review and ecological estimation through extrapolation of mortality trends (DEIS 2002-2015), applying incidence-to-mortality ratios from the Global Burden of Disease study. A sensitivity analysis was performed applying the ratio from middle-income countries of the same source. Public procurement data (Mercado Público and Chile- Compra, 2024-2025) were analyzed to determine actual therapeutic coverage. Results: We estimated 2,130 deaths and between 4,405 and 5,687 incident cases annually depending on the scenario applied. Estimated prevalence reaches 22,466 total fibrosing ILD cases for 2025, of which between 11,000 and 13,500 would present a progressive phenotype and constitute effective candidates for antifibrotic ther- apy. The public health system provides 1,027 antifibrotic treatments (970 pirfenidone, 57 nintedanib), representing 4.6% coverage of the total estimated ILD burden and 7.6-9.3% coverage of the progressive phenotype population. Marked territorial inequities exist, with coverage ranging from 2.6% (northern zone) to 6.7% (southern zone). In no scenario does coverage exceed 10% of the target population. Conclusion: The access gap to antifibrotic therapies reveals a public health problem requiring the formal incorporation of fibrosing interstitial lung diseases into guaranteed health coverage programs (GES/Ley Ricarte Soto).