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Rheumatology Advance Access originally published online on June 1, 2004
Rheumatology 2004 43(8):1016-1024; doi:10.1093/rheumatology/keh229
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Rheumatology Vol. 43 No. 8 © British Society for Rheumatology 2004; all rights reserved

Paper

The systemic lupus erythematosus Tri-nation Study: absence of a link between health resource use and health outcome

A. E. Clarke1,2, M. Petri3, S. Manzi4, D. A. Isenberg5, C. Gordon6, J.-L. Senécal7, J. Penrod2,8, L. Joseph2,9, Y. St Pierre2, P. R. Fortin10, N. Sutcliffe5, J. Richard Goulet7, D. Choquette7, T. Grodzicky7 and J. M. Esdaile11 for the Tri-nation Study Group{dagger}

1 Divisions of Clinical Immunology and Allergy and 2 Clinical Epidemiology, Department of Medicine McGill University Health Centre and Departments of 8 Economics and 9 Epidemiology and Biostatistics, McGill University, Montréal, Québec, Canada, 3 Department of Medicine (Division of Rheumatology), Johns Hopkins University School of Medicine, Baltimore, MD, 4 Department of Medicine (Division of Rheumatology) and Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA, 5 Centre for Rheumatology, Department of Medicine, University College London, London, 6 Department of Rheumatology, University of Birmingham, Birmingham, UK, 7 Department of Medicine (Division of Rheumatology), Hôpital Notre-Dame, Université de Montréal, Montréal, Québec, 10 Department of Medicine (Division of Rheumatology) and Department of Epidemiology, University of Toronto, Toronto, Ontario and 11 Arthritis Research Centre of Canada and Department of Medicine, University of British Columbia, Vancouver, BC, Canada.

Correspondence to: A. Clarke, Division of Clinical Epidemiology, Room L10-413, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada. E-mail: ann.clarke{at}mcgill.ca

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 4 yr [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.

KEY WORDS: Systemic lupus erythematosus, Economics, Disease damage, SLICC damage index, Direct health care costs

{dagger}Tri-nation staff: Montreal General Hospital: T. Panaritis, P. Panaritis, K. Margonis, M. Trifero, D. Ferland, C. Neville, M. Orsini-Dudin; University of Pittsburgh: J. Rairie; University of Birmingham: S. Heaton.


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