Rheumatology Advance Access originally published online on March 9, 2005
Rheumatology 2005 44(6):751-755; doi:10.1093/rheumatology/keh580
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The systemic lupus erythematosus tri-nation study: longitudinal changes in physical and mental well-being
Department of Medicine (Divisions of 1 Rheumatology, 2 Clinical Epidemiology, and 3 Clinical Immunology/Allergy), 9 McGill University Health Centre and Departments of Economics and 10 Biostatistics, 4 McGill University, Montréal, Québec, Canada, Department of Medicine (Division of Rheumatology), Johns Hopkins University School of Medicine, Baltimore, MD, 5 Department of Medicine (Division of Rheumatology) and Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA, 6 Centre for Rheumatology, Department of Medicine, University College London, London, UK, 7 Department of Rheumatology, Division of Immunity and Infection, University of Birmingham, Birmingham, UK, 8 Department of Medicine (Division of Rheumatology), Hôpital Notre-Dame, Université de Montréal, Montréal, Québec, 11 Department of Medicine (Division of Rheumatology) and Department of Epidemiology, University of Toronto, Toronto, Ontario and 12 Arthritis Research Centre of Canada and Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
Correspondence to: Ann Clarke, MD, MSc, Division of Clinical Epidemiology, Room L10-413, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4. E-mail: ann.clarke{at}mcgill.ca
Objective. We have shown that SLE patients in Canada and the UK incurred 20% and 13% lower health costs than those in the US, respectively, but did not experience worse outcomes as expressed by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. We now compare change in quality of life in these patients.
Patients and methods. Seven hundred and fifteen SLE patients (Canada 231, US 269, UK 215) completed the SF-36 annually over four years. The annual change in the SF-36 Physical and Mental Component Summary (PCS and MCS) scores over the course of the study were summarized by estimating a linear trend for each individual patient using hierarchical modelling. Cross-country comparison of the slopes in the PCS and MCS scores was then performed using simultaneous regressions.
Results. The estimated mean annual changes (95% credible interval [CrI]) in the PCS scores in Canada, the US, and the UK were 0.18 (–0.07, 0.43), –0.05 (–0.27, 0.17), and 0.03 (–0.20, 0.27), respectively; the mean annual changes in the MCS scores were 0.15 (–0.04, 0.34), 0.23 (0.09, 0.37), and 0.08 (–0.10, 0.27), respectively. Regression results showed that the mean annual changes in PCS and MCS scores did not substantially differ across countries.
Conclusion. Quality of life remained stable across countries. Despite Canadian and British patients incurring lower health costs, on average, patients experienced similar changes in physical and mental well-being.
KEY WORDS: Quality of life, Health status, Systemic lupus erythematosus, Disease damage, Direct healthcare costs
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