TY - JOUR
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, M.
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.
N1 - Funding Information:
The authors thank all the participating physicians (University of Birmingham: M. Allen, S. Bowman), E. Toto and J. Gardner for their expert technical assistance, and the patients whose contribution made this study possible. This work was supported by grants from the Fonds de la recherche en santé du Québec and The Arthritis Society of Canada. The Montreal General Lupus Cohort is partially supported by the Singer Family Fund for Lupus Research; the Hopkins Lupus Cohort is supported by National Institutes of Health RO1 AR43727 and by the Outpatient Clinical Research Center, RR 00722; the Pittsburgh Cohort is supported by the Lupus Foundation, Pennsylvania Chapter, K24 AR00213, and NIH RO1 AR46588, Arthritis Foundation, National, NIH/5RO1 AL54900-02; the Birmingham Cohort is supported in part by the Wellcome Trust Clinical Research Facility and Lupus UK. A.E.C. is an Investigator of the Canadian Institutes for Health Research; M.P. is supported by RO1 AR43727-06 and RR00052; L.J. is a Senior Investigator of the Canadian Institutes for Health Research; P.R.F. is an Investigator of The Arthritis Society and the Director of Clinical Research at the Arthritis Centre of Excellence.
PY - 2004/8
Y1 - 2004/8
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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U2 - 10.1093/rheumatology/keh229
DO - 10.1093/rheumatology/keh229
M3 - Article
C2 - 15173602
AN - SCOPUS:4243164509
SN - 1462-0324
VL - 43
SP - 1016
EP - 1024
JO - Rheumatology
JF - Rheumatology
IS - 8
ER -