DECREASING COSTS AND IMPROVING OUTCOMES IN SYSTEMIC LUPUS-ERYTHEMATOSUS - USING REGRESSION TREES TO DEVELOP HEALTH-POLICY

Objective. To characterize patients with systemic lupus erythematosus (SLE) who are expected to experience the highest direct and indirect m onetary costs and greatest diminished productivity so that we may inte rvene to reduce costs and improve outcomes. Methods. We assessed demog raphics and health status in January, 1990 and costs incurred in the l ast 6 months of 1990 in January, 1991 in 151 patients with SLE enrolle d in the Montreal General Hospital Lupus Registry. We used regression trees to separate low from high cost patients. Results. Patients with poor physical or poor psychological functioning incur the highest dire ct costs (3-fold and 1.6-fold the group mean, respectively); those wit h the poorest psychological functioning incur the highest indirect cos ts (2-fold the group average); and those with the most intense pain ex perience the greatest impairment in productivity (3-fold the group ave rage). Conclusion. Targeting patients with poor physical and psycholog ical functioning and substantial pain with appropriate interventions m ay improve their outcomes and reduce disease costs. Targeting patients expected to have low costs with preventative interventions may delay worse outcomes and reduce future costs.