title: The systemic lupus erythematosus Tri-Nation study: cumulative indirect costs.
abstract: OBJECTIVE
  We previously reported that patients with systemic lupus erythematosus (SLE) in the US incurred approximately 19% and 12% higher direct medical costs than patients in Canada and the UK, respectively, without experiencing superior outcomes expressed as disease damage or quality of life. In the present study, we compared cumulative indirect costs over 4 years in these patients.
  
  
  METHODS
  A total of 715 patients with SLE (269 US, 231 Canada, 215 UK) were surveyed semiannually for 4 years on employment status and time lost from labor and nonlabor market activities. Cross-country comparisons of indirect costs were performed.
  
  
  RESULTS
  In the US, Canada, and the UK, mean 4-year cumulative indirect costs (95% confidence interval [95% CI]) due to diminished labor market activity were $56,745 ($49,919, $63,571), $38,642 ($32,785, $44,500), and $42,213 ($35,859, $48,567), respectively, and cumulative indirect costs due to diminished nonlabor market activity were $5,249 ($2,766, $7,732), $5,455 ($3,290, $7,620), and $8,572 ($5,626, $11,518), respectively. Regression results showed that cumulative indirect costs (95% CI) due to diminished labor market activity in the US were $6,750 ($580, $12,910) greater than in Canada and $10,430 ($4,050, $16,800) greater than in the UK. Indirect costs due to diminished nonlabor market activity in the US were $280 (-$2,950, $3,520) less than in Canada and $2,010 (-$1,490, $5,510) less than in the UK, both results insignificant due to wide CIs.
  
  
  CONCLUSIONS
  Despite American patients incurring greater direct medical costs than Canadian and British patients, they do not experience superior health outcomes in terms of less productivity loss in either labor market or nonlabor market activities.
authors.affiliation: McGill University, Montréal, Qué-bec, Canada.
authors.forename: Pantelis
authors.initials: P
authors.lastname: Panopalis
authors.forename: Michelle
authors.initials: M
authors.lastname: Petri
authors.forename: Susan
authors.initials: S
authors.lastname: Manzi
authors.forename: David A
authors.initials: DA
authors.lastname: Isenberg
authors.forename: Caroline
authors.initials: C
authors.lastname: Gordon
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Senécal
authors.forename: John R
authors.initials: JR
authors.lastname: Penrod
authors.forename: Lawrence
authors.initials: L
authors.lastname: Joseph
authors.forename: Yvan
authors.initials: Y
authors.lastname: St Pierre
authors.forename: Christian
authors.initials: C
authors.lastname: Pineau
authors.forename: Paul R
authors.initials: PR
authors.lastname: Fortin
authors.forename: Nurhan
authors.initials: N
authors.lastname: Sutcliffe
authors.forename: Jean-Richard
authors.initials: JR
authors.lastname: Goulet
authors.forename: Denis
authors.initials: D
authors.lastname: Choquette
authors.forename: Tamara
authors.initials: T
authors.lastname: Grodzicky
authors.forename: John M
authors.initials: JM
authors.lastname: Esdaile
authors.forename: Ann E
authors.initials: AE
authors.lastname: Clarke
mesh_terms: D002170:Canada; D017281:Cost of Illness; D004526:Efficiency; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000191:economics*; D017063:Outcome Assessment, Health Care / Q000191:economics; D012044:Regression Analysis; D013997:Time Factors; D006113:United Kingdom; D014481:United States