An international perspective on the well being and health care costs for patients with systemic lupus erythematosus

Objective. To compare health care expenditure and health status for patient s with systemic lupus erythematosus (SLE) between nations with distinct mec hanisms for funding and delivering health care services. Methods. Seven hundred eight patients with SLE from 2 centers in each of 3 countries (Canada 229, United States 268, United Kingdom 211) underwent phy sician assessment of disease activity and damage and reported on physical a nd psychosocial well being, satisfaction, social support, and health resour ce utilization. To compare overall utilization, constant prices (1997 Canad ian dollars) were applied across countries for each service, enabling diver se resources to be collapsed into a single expression. Results. After adjusting for important patient covariates, Canadian, compar ed to American and British patients, reported significantly superior health status in 3 of 8 Medical Outcome Survey Short form-36(TM) (SF-36) subscale s, the SF-36 physical component summary score, and the visual analog scale of general health status. There was no consistent trend in patient satisfac tion, Overall annual resource utilization did not vary significantly, with mean annual per patient expenditures (adjusted for demographics, disease du ration, activity, damage, social support, health status, patient satisfacti on, and age and sex adjusted country-specific SF-36 general population norm s) totalling $4853, $5285, and $4760 for Canada, US, and the UK, respective ly. However, within each resource category, differences were observed. Cana dians saw more specialists than the British, the British more,generalists. Canadians and Americans were more frequent users of the emergency room; Ame ricans of laboratory/imaging procedures. Canadians had higher hospital cost s than Americans. Conclusion. After adjustment, Canadian patients reported better well being than their counterparts. Despite considerable differences in the mechanisms of health care funding and service mixture, overall resource utilization d id not vary significantly between the countries, although there was a trend towards more intense use of inpatient services in Canada and outpatient se rvices in the United States.