The systemic lupus erythematosus tri-nation study: Absence of a link between health resource use and health outcome

Ann E. Clarke, Michelle Petri, S. Manzi, D. A. Isenberg, C. Gordon, J. L. Senécal, J. Penrod, L. Joseph, Y. St Pierre, P. R. Fortin, N. Sutcliffe, J. Richard Goulet, D. Choquette, T. Grodzicky, J. M. Esdaile, T. Panaritis, P. Panaritis, K. Margonis, M. Trifero, D. FerlandC. Neville, M. Orsini-Dudin, J. Rairie, S. Heaton

Research output: Contribution to journalArticle

Abstract

Objective. Health consumption and health status in SLE in three countries with different health funding structures were compared. Methods. Seven hundred and fifteen SLE patients (Canada 231, USA 269, UK 215) were surveyed semi-annually over 4 yr for health resource utilization and health status. Cross-country comparisons of (i) cumulative health expenditure (calculated by applying 2002 Canadian prices to resources in all countries) and (ii) disease damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, SLICC/ACR DI) at study conclusion were performed after adjustment. Missing expenditure and damage data were managed through multiple imputation using best predictive regressions with all available data from all patients as potential covariates. Results. Four hundred and eighty-five patients provided data at study entry and conclusion and at least four resource questionnaires (Canada 162, USA 157, UK 166); 41 died (Canada 13, USA 18, UK 10); 189 withdrew, were lost to follow-up or provided data at entry and conclusion but fewer than four resource questionnaires (Canada 56, USA 94, UK 39). At conclusion, after imputation, in Canada, the USA and the UK respectively, mean cumulative costs per patient over 4yr [95% confidence interval (CI)] were $15 845 (13 509, 18 182), $20 244 (17 764, 22 724) and $17 647 (15 557, 19 737) and mean changes in SLICC/ACR DI were 0.49 (0.39, 0.60), 0.63 (0.52, 0.74) and 0.48 (0.39, 0.57). After adjustment for baseline differences, on average (95% CI), Canadian and British patients utilized 20% (8%, 32%) and 13% (1%, 24%) less resources than patients in the USA respectively, but experienced similar health outcomes. Conclusion. Despite patients in the USA incurring higher health expenditures, they did not experience superior health outcomes.

Original languageEnglish (US)
Pages (from-to)1016-1024
Number of pages9
JournalRheumatology
Volume43
Issue number8
DOIs
StatePublished - Aug 2004

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Health Resources
Systemic Lupus Erythematosus
Canada
Health
Health Expenditures
Health Status
Confidence Intervals
Lost to Follow-Up
Rheumatology
Costs and Cost Analysis

Keywords

  • Direct health care costs
  • Disease damage
  • Economics
  • SLICC damage index
  • Systemic lupus erythematosus

ASJC Scopus subject areas

  • Neuroscience(all)
  • Rheumatology

Cite this

The systemic lupus erythematosus tri-nation study : Absence of a link between health resource use and health outcome. / Clarke, Ann E.; Petri, Michelle; Manzi, S.; Isenberg, D. A.; Gordon, C.; Senécal, J. L.; Penrod, J.; Joseph, L.; St Pierre, Y.; Fortin, P. R.; Sutcliffe, N.; Goulet, J. Richard; Choquette, D.; Grodzicky, T.; Esdaile, J. M.; Panaritis, T.; Panaritis, P.; Margonis, K.; Trifero, M.; Ferland, D.; Neville, C.; Orsini-Dudin, M.; Rairie, J.; Heaton, S.

In: Rheumatology, Vol. 43, No. 8, 08.2004, p. 1016-1024.

Research output: Contribution to journalArticle

Clarke, AE, Petri, M, Manzi, S, Isenberg, DA, Gordon, C, Senécal, JL, Penrod, J, Joseph, L, St Pierre, Y, Fortin, PR, Sutcliffe, N, Goulet, JR, Choquette, D, Grodzicky, T, Esdaile, JM, Panaritis, T, Panaritis, P, Margonis, K, Trifero, M, Ferland, D, Neville, C, Orsini-Dudin, M, Rairie, J & Heaton, S 2004, 'The systemic lupus erythematosus tri-nation study: Absence of a link between health resource use and health outcome', Rheumatology, vol. 43, no. 8, pp. 1016-1024. https://doi.org/10.1093/rheumatology/keh229
Clarke, Ann E. ; Petri, Michelle ; Manzi, S. ; Isenberg, D. A. ; Gordon, C. ; Senécal, J. L. ; Penrod, J. ; Joseph, L. ; St Pierre, Y. ; Fortin, P. R. ; Sutcliffe, N. ; Goulet, J. Richard ; Choquette, D. ; Grodzicky, T. ; Esdaile, J. M. ; Panaritis, T. ; Panaritis, P. ; Margonis, K. ; Trifero, M. ; Ferland, D. ; Neville, C. ; Orsini-Dudin, M. ; Rairie, J. ; Heaton, S. / The systemic lupus erythematosus tri-nation study : Absence of a link between health resource use and health outcome. In: Rheumatology. 2004 ; Vol. 43, No. 8. pp. 1016-1024.
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abstract = "Objective. Health consumption and health status in SLE in three countries with different health funding structures were compared. Methods. Seven hundred and fifteen SLE patients (Canada 231, USA 269, UK 215) were surveyed semi-annually over 4 yr for health resource utilization and health status. Cross-country comparisons of (i) cumulative health expenditure (calculated by applying 2002 Canadian prices to resources in all countries) and (ii) disease damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, SLICC/ACR DI) at study conclusion were performed after adjustment. Missing expenditure and damage data were managed through multiple imputation using best predictive regressions with all available data from all patients as potential covariates. Results. Four hundred and eighty-five patients provided data at study entry and conclusion and at least four resource questionnaires (Canada 162, USA 157, UK 166); 41 died (Canada 13, USA 18, UK 10); 189 withdrew, were lost to follow-up or provided data at entry and conclusion but fewer than four resource questionnaires (Canada 56, USA 94, UK 39). At conclusion, after imputation, in Canada, the USA and the UK respectively, mean cumulative costs per patient over 4yr [95{\%} confidence interval (CI)] were $15 845 (13 509, 18 182), $20 244 (17 764, 22 724) and $17 647 (15 557, 19 737) and mean changes in SLICC/ACR DI were 0.49 (0.39, 0.60), 0.63 (0.52, 0.74) and 0.48 (0.39, 0.57). After adjustment for baseline differences, on average (95{\%} CI), Canadian and British patients utilized 20{\%} (8{\%}, 32{\%}) and 13{\%} (1{\%}, 24{\%}) less resources than patients in the USA respectively, but experienced similar health outcomes. Conclusion. Despite patients in the USA incurring higher health expenditures, they did not experience superior health outcomes.",
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T1 - The systemic lupus erythematosus tri-nation study

T2 - Absence of a link between health resource use and health outcome

AU - Clarke, Ann E.

AU - Petri, Michelle

AU - Manzi, S.

AU - Isenberg, D. A.

AU - Gordon, C.

AU - Senécal, J. L.

AU - Penrod, J.

AU - Joseph, L.

AU - St Pierre, Y.

AU - Fortin, P. R.

AU - Sutcliffe, N.

AU - Goulet, J. Richard

AU - Choquette, D.

AU - Grodzicky, T.

AU - Esdaile, J. M.

AU - Panaritis, T.

AU - Panaritis, P.

AU - Margonis, K.

AU - Trifero, M.

AU - Ferland, D.

AU - Neville, C.

AU - Orsini-Dudin, M.

AU - Rairie, J.

AU - Heaton, S.

PY - 2004/8

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N2 - Objective. Health consumption and health status in SLE in three countries with different health funding structures were compared. Methods. Seven hundred and fifteen SLE patients (Canada 231, USA 269, UK 215) were surveyed semi-annually over 4 yr for health resource utilization and health status. Cross-country comparisons of (i) cumulative health expenditure (calculated by applying 2002 Canadian prices to resources in all countries) and (ii) disease damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, SLICC/ACR DI) at study conclusion were performed after adjustment. Missing expenditure and damage data were managed through multiple imputation using best predictive regressions with all available data from all patients as potential covariates. Results. Four hundred and eighty-five patients provided data at study entry and conclusion and at least four resource questionnaires (Canada 162, USA 157, UK 166); 41 died (Canada 13, USA 18, UK 10); 189 withdrew, were lost to follow-up or provided data at entry and conclusion but fewer than four resource questionnaires (Canada 56, USA 94, UK 39). At conclusion, after imputation, in Canada, the USA and the UK respectively, mean cumulative costs per patient over 4yr [95% confidence interval (CI)] were $15 845 (13 509, 18 182), $20 244 (17 764, 22 724) and $17 647 (15 557, 19 737) and mean changes in SLICC/ACR DI were 0.49 (0.39, 0.60), 0.63 (0.52, 0.74) and 0.48 (0.39, 0.57). After adjustment for baseline differences, on average (95% CI), Canadian and British patients utilized 20% (8%, 32%) and 13% (1%, 24%) less resources than patients in the USA respectively, but experienced similar health outcomes. Conclusion. Despite patients in the USA incurring higher health expenditures, they did not experience superior health outcomes.

AB - Objective. Health consumption and health status in SLE in three countries with different health funding structures were compared. Methods. Seven hundred and fifteen SLE patients (Canada 231, USA 269, UK 215) were surveyed semi-annually over 4 yr for health resource utilization and health status. Cross-country comparisons of (i) cumulative health expenditure (calculated by applying 2002 Canadian prices to resources in all countries) and (ii) disease damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index, SLICC/ACR DI) at study conclusion were performed after adjustment. Missing expenditure and damage data were managed through multiple imputation using best predictive regressions with all available data from all patients as potential covariates. Results. Four hundred and eighty-five patients provided data at study entry and conclusion and at least four resource questionnaires (Canada 162, USA 157, UK 166); 41 died (Canada 13, USA 18, UK 10); 189 withdrew, were lost to follow-up or provided data at entry and conclusion but fewer than four resource questionnaires (Canada 56, USA 94, UK 39). At conclusion, after imputation, in Canada, the USA and the UK respectively, mean cumulative costs per patient over 4yr [95% confidence interval (CI)] were $15 845 (13 509, 18 182), $20 244 (17 764, 22 724) and $17 647 (15 557, 19 737) and mean changes in SLICC/ACR DI were 0.49 (0.39, 0.60), 0.63 (0.52, 0.74) and 0.48 (0.39, 0.57). After adjustment for baseline differences, on average (95% CI), Canadian and British patients utilized 20% (8%, 32%) and 13% (1%, 24%) less resources than patients in the USA respectively, but experienced similar health outcomes. Conclusion. Despite patients in the USA incurring higher health expenditures, they did not experience superior health outcomes.

KW - Direct health care costs

KW - Disease damage

KW - Economics

KW - SLICC damage index

KW - Systemic lupus erythematosus

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