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Trenaman L, Kaal KJ, Laba TL, Safari A, Aguiar M, Burch T, Beckett J, Munro S, Hudson M, Harrison M. The financial burden of accessing care for people with scleroderma in Canada: a patient-oriented, cross-sectional survey. CMAJ Open 2023; 11:E630-E636. [PMID: 37437955 PMCID: PMC10356003 DOI: 10.9778/cmajo.20220227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Patients with scleroderma require a lifetime of treatment and frequent contacts with rheumatologists and other health care professionals. Although publicly funded health care systems in Canada cover many costs, patients may still face a substantial financial burden in accessing care. The purpose of this study was to quantify out-of-pocket costs borne by people with scleroderma in Canada and compare this burden for those living in large communities and smaller communities. METHODS We analyzed responses to a Web-based survey of people living in Canada with scleroderma. Respondents reported annual out-of-pocket medical, travel and accommodation and other nonmedical costs (2019 Canadian dollars). We used descriptive statistics to describe travel distance and out-of-pocket costs. We used a 2-part model to estimate the impact on out-of-pocket costs of living in a large urban centre (≥ 100 000 population), compared with smaller urban centres or rural areas (< 100 000 population). We generated combined mean estimates from the 2-part models using predictive margins. RESULTS The survey included 120 people in Canada with scleroderma. The mean, annual, total out-of-pocket costs were $3357 (standard deviation $5580). Respondents living in smaller urban centres and rural areas reported higher mean total costs ($4148, 95% confidence interval [CI] $3618-$4680) and travel or accommodation costs ($1084, 95% CI $804-$1364) than those in larger urban centres (total costs $2678, 95% CI $2252-$3104; travel or accommodation costs $332, 95% CI $207-$458). INTERPRETATION Many patients with scleroderma incur considerable out-of-pocket costs, and this burden is exacerbated for those living in smaller urban centres and rural areas. Health care systems and providers should consider ways to alleviate this burden and support equitable access to care.
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Affiliation(s)
- Logan Trenaman
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - K Julia Kaal
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Tracey-Lea Laba
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Abdollah Safari
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Magda Aguiar
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Tiasha Burch
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Jennifer Beckett
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Sarah Munro
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Marie Hudson
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
| | - Mark Harrison
- Centre for Health Evaluation and Outcome Sciences (Trenaman, Munro, Harrison), Vancouver, BC; Department of Community Health and Epidemiology (Kaal), Dalhousie University, Halifax, NS; Clinical and Health Sciences Unit (Laba), The University of South Australia, Adelaide, Australia; Centre for Health Economics Research and Evaluation (Laba), University of Technology, Sydney, Australia; College of Science (Safari), School of Mathematics, Statistics and Computer Science, University of Tehran, Tehran, Iran; Collaboration for Outcomes Research and Evaluation (Aguiar, Harrison), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC; Scleroderma Association of British Columbia (Burch), North Vancouver, BC; Patient partner (Burch), Vancouver, BC; Patient partner (Beckett), Kamloops, BC; Department of Obstetrics and Gynaecology (Munro), University of British Columbia, Vancouver, BC; Division of Rheumatology (Hudson), Jewish General Hospital and Lady Davis Institute; Department of Medicine (Hudson), McGill University, Montréal, Que.; Arthritis Research Canada (Hudson, Harrison), Vancouver, BC
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