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Arthritis Patient Education: How Economic Evaluations Can Inform Health Policy

Published online by Cambridge University Press:  08 November 2023

Ann E. Clarke
Ann E. Clarke*
Affiliation:
Montreal General Hospital
*
Requests for reprints should be sent to:/Les demandes de reproduction doivent être adressées à: Ann E. Clarke, Divisions of Clinical Epidemiology and Clinical Immunology/Allergy, Montreal General Hospital, 1650 Cedar Avenue, Montreal, PQ H3G 1A4
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Abstract

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As Canadian health policy-makers struggle to contain costs while maintaining quality, patient education is promoted as making patients more effective producers of health and consumers of health care. Assessment of existing psychoeducational interventions has concentrated on knowledge enhancement, behaviour modification, and health status while economic outcomes have remained unexplored. Given that such programs are likely to be effective, but costly, economic appraisals are necessary to convince cost-conscious policy-makers. This manuscript describes a cost-effectiveness evaluation of the Arthritis Self-Management Program (ASMP) that I and my collaborators are conducting by randomizing participants to the ASMP as an adjunct to usual medical care versus usual medical care. Direct and indirect costs are evaluated through self-reporting of health services utilization and diminished productivity and effectiveness through a visual analogue scale and the SF-36. To influence health policy, the results must be disseminated to public health authorities, private insurers, and patient and health professional organizations, thereby encouraging funding, increasing awareness, and promoting participation.

Résumé

Résumé

Dans le cadre de la lutte des responsables de l'élaboration des politiques de santé pour endiguer les coûts tout en maintenant la qualité, on promouvoit l'éducation des patients comme moyen d'amélioration de la santé et de recours plus dosé aux soins de santé. L'évaluation des interventions psychopedagogiques en place s'est concentrée sur 1'amélioration des connaissances, la modification du comportement et l'état de santé mais les résultats économiques n'ont pas été explorés. Étant donné que ces programmes pourraient étre efficaces mais coûteux, il est essentiel d'en faire I'evaluation économique pour mieux convaincre les responsables de l'élaboration des politiques pour qui les coûts constituent un élément important. Ce document présente une évaluation du Arthritis Self-Management Program (ASMP) que j'effectue avec mes collaborateurs en randomisant les participants qui ont ajouté l'ASMP aux soins habituels par comparaison a l'utilisation stricte des soins de santé habituels. Les coûts directs et indirects sont vérifiés par auto-évaluation de l'utilisation des services de santé ainsi qu'en fonction d'une diminution de la productivité et l'efficacité est établie par une échelle analogue visuelle et le SF-36. Les résultats obtenus, si Ton souhaite qu'ils influencent les politiques de santé, doivent être diffusés aux services de santé publique, aux assureurs privés, aux patients et aux organismes professionnels de santé, ce qui a pour effet de favoriser le financement, d'augmenter la sensibilisation et de promouvoir la participation.

Keywords

ArthritisPatient EducationCost-EffectivenessQuality of LifeHealth Care CostsArthriteéducation des patientsrapport coût-efficacitéqualité de viecoûts des soins de santé
Type
Research Article
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 16 , Issue S1: Bridging Policy and Research on Aging/Tisser des liens entre les politiques et la recherche relative au vieillissement , Spring Printemps 1997 , pp. 162 - 176
Copyright
Copyright © Canadian Association on Gerontology 1997

Footnotes

*

The author wishes to thank the Principal Investigator in this SIRP-funded study, Patrick McGowan, PhD, Research Associate, Institute of Health Promotion and Research, University of British Columbia, for helpful discussions as well as Steven Grover, MD, MPH and Hanna Zowall, MA of the Division of Clinical Epidemiology, Montreal General Hospital for assistance in developing the costing methodology. This work is supported by the Seniors' Independence Research Program (SIRP) of the National Health Research and Development Program.

References

Badley, E.M. (ed). The economic burden of musculoskeletal disorders in Canada is similar to that for cancer, and may be higher. J Rheumatol 1995; 22:204-6.Google Scholar
Badley, E.M., Rasooly, I., Webster, G.K.. Relative importance of musculoskeletal disorders as a cause of chronic health problems, disability, and health care utilization: findings from the 1990 Ontario Health Survey. J Rheumatol 1994; 21:505-14.Google Scholar
Martin, J., Meltzer, H., Elliot D. The prevalence of disability among adults. OPCS Surveys of Disability in Great Britain Report 1. OPCS Social Survey Division. London: Her Majesty's Stationery Office, 1988.Google Scholar
Kosorok, M.R., Omenn, G.S., Diehr, P., Koepsell, T.D., Patrick, D.L.. Restricted activity days among older adults. Am J Public Health 1992; 82:1263-7.CrossRefGoogle Scholar
Schappert, S.M.. National ambulatory medical care survey: 1989 summary. Hyattsville, MD: National Center for Health Statistics, 1992; DHHS Publication No. (PHS) 92-1771. (Vital and Health Statistics, Series 13, no. 110).Google Scholar
Yelin, E., Callahan, L.F. for the National Arthritis Data Work Group. The economic cost and social and psychological impact of musculoskeletal conditions. Arthritis Rheum 1995; 38:1351-62.CrossRefGoogle Scholar
Felts, W., Yelin E. The economic impact of the rheumatic diseases in the United States. J Rheumatol 1989; 16:867-84.Google Scholar
Angus, D.E., Auer, L., Cloutier, J.E., Albert T. Sustainable health care for Canada. Queen's University of Ottawa Economic Project, 1995.Google Scholar
Mhatre, S.L., Deber, R.B.. From equal access to health care to equitable access to health: a review of Canadian provincial health commissions and reports. Int J Health Services 1992; 22:645-68.CrossRefGoogle Scholar
Clarke, A.E., Esdaile, J.M., Bloch, D.A., Lacaille, D., Danoff, D.S., Fries, J.F.. A Canadian study of the total medical costs for patients with systemic lupus erythematosus and the predictors of costs. Arthritis Rheum 1993; 36:1548-59.CrossRefGoogle Scholar
Hawley, D.J., Wolfe F. Anxiety and depression in patients with rheumatoid arthritis: a prospective study of 400 patients. J Rheumatol 1988; 15:932-41.Google Scholar
Katz, P.P., Yelin, E.H.. Prevalence and correlates of depressive symptoms among persons with rheumatoid arthritis. J Rheumatol 1993; 20:790-6.Google Scholar
Green, L.W., Kreuter, M.W., Deeds, S.G., Partridge, K.B.. Health education planning: A diagnostic approach. Palo Alto, CA: Mayfield Publication Company, 1980.Google Scholar
Daltroy, L.H., Liang, M.H.. Arthritis education: opportunities and state of the art. Health Education Quarterly 1993; 20:3-16.CrossRefGoogle Scholar
Hirano, P.C., Laurent, D.D., Lorig K. Arthritis patient education studies, 1987-1991: A review of the literature. Patient Educ Counsel 1994; 24:9-54.CrossRefGoogle Scholar
Lorig, K., Kondol, L., Gonzalez V. Arthritis patient education: A review of the literature. Patient Educ Counsel 1987; 10:207-52.CrossRefGoogle Scholar
Mazzuca, S.A.. Does patient education in chronic disease have therapeutic value? J Chronic Dis 1982; 35:521-9.CrossRefGoogle Scholar
Mullen, P.D., Laville, E.A., Biddle, A.K., Lorig K. Efficacy of psycho-educational interventions on pain, depression, and disability with arthritic adults: A meta-analysis. J Rheumatol 1987; 14(Suppl 15):33-39.Google Scholar
Mazzuca, S.A.. Economic evaluation of arthritis patient education. Bull Rheum Dis 1994; 43:6-8.Google Scholar
Lorig, K.R., Mazonson, P.D., Holman, H.R.. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum 1993; 36:439-46.CrossRefGoogle Scholar
Weinberger, M., Tierney, W.M., Cowper, P.A., Katz, B.P., Booher, P.A.. Cost-effectiveness of increased telephone contact for patients with osteoarthritis. Arthritis Rheum 1993; 36:243-6.CrossRefGoogle Scholar
Laupacis, A., Feeny, D., Detsky, A.S., Tugwell, P.X.. How attractive does a new technology have to be to warrant adoption and utilization? Tentative guidelines for using clinical and economic evalutions. Can Med Assoc J 1992; 146:473-81.Google Scholar
Lambert, C.M., Hurst, N.P.. Health economics as an aspect of health outcome: basic principles and application in rheumatoid arthritis. Br J Rheumatol 1995; 34:774-80.CrossRefGoogle Scholar
Clarke, A.E., Esdaile, J.M., Hawkins D (eds). Inpatient rheumatic disease units: Are they worth it? Arthritis Rheum 1993; 36:1337-40.CrossRefGoogle Scholar
Drummond, M.F., Stoddart, G.L., Torrance, G.W.. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press, 1987.Google Scholar
Canadian Coordinating Office for Health Technology Assessment. Guidelines for economic evaluation of Pharmaceuticals: Canada. (1st ed.) Ottawa: Canadian Coordinating Office for Health Technology Assessment, November 1994.Google Scholar
Russell, L.B., Gold, M.R., Siegel, J.E., Daniels, N., Weinstein, M.C.. The role of cost-effectiveness analysis in health and medicine. JAMA 1996; 276:1172-7.CrossRefGoogle Scholar
Weinstein, M.C., Siegel, J.E., Gold, M.R., Kamlet, M.S., Russell, L.B.. Recommendations of the panel on cost-effectiveness in health and medicine. JAMA 1996; 276:1253-8.CrossRefGoogle Scholar
Siegel, J.E., Weinstein, M.C., Russell, L.B., Gold, M.R.. Recommendations for reporting cost-effectiveness analyses. JAMA 1996; 276:1339^1.CrossRefGoogle Scholar
Sloan, F.A.. Valuing health care: Costs, benefits, and effectiveness of pharmaceuticals, and other medical technologies. New York, NY: Cambridge University Press, 1996.Google Scholar
Ware, J.E. Jr, Sherbourne, C.D.. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992; 30:473-83.CrossRefGoogle Scholar
Bozzette, S.A., Hays, R.D., Berry, S.H., Kanouse, D.E.. A perceived health index for use in persons with advanced HIV disease: derivation, reliability, and validity. Med Care 1994; 32:716-31.CrossRefGoogle Scholar
Ware, J.E. Jr, Kosinski, M., Keller, S.D.. SF-36 Physical and mental health summary scales: A user's manual. Boston, MA: The Health Institute, New England Medical Center, December, 1994.Google Scholar
Patrick, D.L., Erickson P. Health status and health policy: Allocating resources to health care. New York, NY: Oxford University Press, 1993.Google Scholar
Froberg, D.G., Kane, R.L.. Methodology for measuring health-state preferences - II: Scaling methods. J Clin Epidemiol 1989; 42:459-71.CrossRefGoogle Scholar
Torrance, G.W.: Measurement of health state utilities for economic appraisal: A review. Journal of Health Econ 1986; 5:1-30.CrossRefGoogle Scholar
Torrance, G.W., Feeny D. Utilities and quality-adjusted life years. Intl J of Tech Assess Health Care 1989; 5:559-75.CrossRefGoogle Scholar
Kahneman, D., Tversky A. Prospect theory. An analysis of decision under risk. Econometrica 1979; 47:263-91.CrossRefGoogle Scholar
Tversky, A., Kahneman D. The framing of decisions and the psychology of choice. Science 1981; 211:453-8.CrossRefGoogle Scholar
Tversky, A., Kahneman D. Judgment under uncertainty: Heuristics and biases. Science 1974; 185:1124-31.CrossRefGoogle Scholar
Kahneman, D., Tversky A. The psychology of preferences. Scientific American 1982; 160-73.CrossRefGoogle Scholar
Torrance, G.W.. Social preferences for health states: An empirical evaluation of three measurement techniques. Socio-Economic Planning Sciences 1976; 10:129-36.CrossRefGoogle Scholar
Drummond, M., Torrance, G., Mason J. Cost-effectiveness league tables: more harm than good? Soc Sci Med 1993; 37:33-40.CrossRefGoogle Scholar
Hodgson, T.A., Meiners, M.R.. Cost-of-illness methodology: A guide to current practices and procedures. Milbank Memorial Fund Quarterly 1982; 60:429-62.CrossRefGoogle Scholar
Statistics Canada. Ageing and independence: Overview of a national survey. Ottawa, 1993.Google Scholar
Clarke, A.E., Zowall, H., Levinton, C., Assimakopoulos, H., Sibley, J.T., Haya, M., Shiroky, J., Neville, C., Lubeck, D.P., Grover, S.A., Esdaile, J.M.. The direct and indirect medical costs incurred by Canadian patients with rheumatoid arthritis: a twelve year study. J Rheumatol 1997; (in press).Google Scholar
Canadian Coordinating Office for Health Technology Assessment. A guidance document for the costing process. Version 1.0. Ottawa: Canadian Coordinating Office for Health Technology Assessment, August 1996.Google Scholar
Finkler, SA. The distinction between cost and charges. Ann Intern Med 1982; 96:102-9.CrossRefGoogle Scholar
Statistics Canada. Hospital statistics: Preliminary annual report. 1992-1993. Ottawa: Catalogue no. 83-241, September 1994.Google Scholar
Statistics Canada. Residential care facilities - aged. 1992-1993. Ottawa: Catalogue no. 83-237, November 1994.Google Scholar
Luce, B.R., Elixhauser A. Estimating costs in the economic evaluation of medical technologies. Int J Tech Assess Health Care 1990; 6:57-75.CrossRefGoogle Scholar
O'Brien, B., Viramontes, J.L.. Willingness to pay: A valid and reliable measure of health state preference? Med Decis Making 1994; 14:289-97.CrossRefGoogle Scholar
Statistics Canada. Selected income statistics. Ottawa: Catalogue no. 93-331, April 1993.Google Scholar
Norland, J.A.. Profile of Canada's Seniors. Ottawa: Statistics Canada and PrenticeGoogle Scholar
Statistics Canada. Employment earnings and hours. Ottawa: Catalogue no. 72-002, November 1995.Google Scholar
Statistics Canada. Households' unpaid work: Measurement and valuation. 1995. Ottawa: Catalogue no. 13-603E, December 1995.Google Scholar
Meenan, R.F.. New approaches to outcome assessment: the AIMS questionnaire for arthritis. Adv Intern Med 1986; 31:167-86.Google Scholar
Fries, J.F., Spitz, P.W., Kraines, R.G., Holman, H.R.. Measurement of patient outcome in arthritis. Arthritis Rheum 1980; 23:137-45.CrossRefGoogle Scholar
Fortin, P.R., Clarke, A.E., Joseph, L., Tanzer, M., Belisle, P., Ferland, D., Phillips, C., Fossel, H.A., Katz, J.N.. A transnational comparison of preoperative status and outcomes of elective total hip/knee replacement. Arthritis Rheum 1996; 39:(Suppl9).Google Scholar
Lindroth, Y., Bauman, A., Barnes, C., McCredie, M., Brooks, P.M.. A controlled evaluation of arthritis education. Br J Rheumatol 1989; 28:7-12.CrossRefGoogle Scholar
Basler, H.D., Rehfisch, H.P.. Cognitive-behavioral therapy in patients with ankylosing spondylitis in a German self-help organization. J Psychosom Res 1991; 35(2/3):345-54.CrossRefGoogle Scholar
Goldenberg, D.L., Kaplan, K.H., Nadeau, M.G.. The impact of cognitive-behavioral therapy on fibromyalgia. Arthritis Rheum 1991; 34(Suppl 9).Google Scholar
Lorig, K., Chastain, R.L., Ung, E., Shoor, S., Holman, H.R.. Development and evaluation of a scale to measure perceived self-efficacy in people with arthritis. Arthritis Rheum 1989; 32:37-44.CrossRefGoogle Scholar