Spring 2018 (Volume 28, Number 1)

Economic Perspectives

By Elena Lopatina, MD, MSc; Deborah A. Marshall, PhD; Vandana Ahluwalia, MD, FRCPC; Stephanie Garner, MD, MSc; Hani El-Gabalawy, MD, FRCPC, FCAHS; Dianne Mosher, MD, FRCPC; and Carter Thorne, MD, FRCPC

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The devastating consequences of inflammatory arthritis (IA) to individual patients and the healthcare system burden associated with the treatment of IA and productivity losses1,2 highlight the need to provide the right care to the right patient at the right time.3

Given the scarcity of healthcare resources and financial constraints,4 the efficiency of care (i.e., optimal use of resources in achieving desired outcomes5) is an important aspect to consider.5,7 Models of care (MOCs) are one approach that is expected to improve accessibility, appropriateness, effectiveness, and safety of care for IA patients8 and, consequently, to improve patient outcomes and increase likelihood of remission9 and reduce the associated medical costs.10-13

From an economic perspective, there may be costs associated with the implementation and operation of MOCs (e.g., education and training of staff, ongoing funding for staff salaries), but this must be balanced against the benefits to patients in terms of improved outcomes and reduced health care costs associated with the management of patients with IA with lower disease activity. MOCs for IA patients thus have the potential to be cost-effective and possibly cost-saving.

The current evidence regarding the efficiency of MOCs for IA patients is limited, especially in local Canadian settings. To draw decision-makers’ attention to and improve uptake of MOCs for arthritis patients, evidence on their efficiency is required. The Arthritis Alliance of Canada (AAC) is currently undertaking a cost consequences analysis of MOCs for IA patients with a specific focus on the access to care element of MOCs for IA patients to demonstrate the benefits of implementing MOCs and explore their efficiency

Dr. Elena Lopatina, PhD candidate, Department of Community Health
Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB

Dr. Deborah A. Marshall, Professor, Department of Community Health
Sciences Cumming School of Medicine, University of Calgary, Calgary, AB

Dr. Vandana Ahluwalia, former Corporate Chief of Rheumatology,
William Osler Health System, Brampton, ON

Dr. Stephanie Garner, MD, MSc, Rheumatology PGY4, McMaster
University, Hamilton, ON

Dr. Hani El-Gabalawy, Professor of Medicine and Immunology; Endowed
Rheumatology Research Chair, University of Manitoba, Winnipeg, MB

Dr. Dianne Mosher, Professor of Medicine, Division Head, Rheumatology,
University of Calgary, Calgary, AB

Dr. Carter Thorne, Rheumatologist/Medical Director, The Arthritis
Program, Southlake Regional Health Centre, Newmarket, ON


1. Marshall DA, Jonsson E, Martin L, et al. Rheumatoid arthritis in a policy perspective. A registry for research and better treatment of Albertans. Institue of Health Economics. 2015.

2. Bombardier C, Hawker G, Mosher D. The impact of arthritis in Canada: today and over the next 30 years. Arthritis Alliance of Canada 2011. Available at Accessed March 12, 2018.

3. Epping-Jordan J, Pruitt S, Bengoa R, et al. Improving the quality of health care for chronic conditions. Qual Saf Health Care 2004; 13(4):299-305. 4. Drummond MF, Sculpher MJ, Claxton K, et al. Methods for the economic evaluation of health care programmes: Oxford University Press; 2015.

5. Alberta Quality Matrix for Health. Health Quality Council of Alberta; 2005.

6. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Affairs 2008; 27(3):759-69.

7. Crossing the quality chasm: a new health system for the 21st century. National Academy Press; 2001. Report No.: 0309073227.

8. Garner S, Lopatina E, Rankin JA, et al. Nurse-led care for patients with rheumatoid arthritis: a systematic review of the effect on quality of care. J Rheumatol 2017; 44(6):757-65.

9. Gwinnutt JM, Symmons DP, MacGregor AJ, et al. The 20-year outcome and association between early treatment and mortality and disability in an inception cohort of patients with rheumatoid arthritis: results from the Norfolk Arthritis Register. Arthritis Rheumatol 2017; 69(8):1566-75.

10. Barnabe C, Thanh NX, Ohinmaa A, et al. Healthcare service utilisation costs are reduced when rheumatoid arthritis patients achieve sustained remission. Ann Rheum Dis 2013; 72(10):1664-8.

11. Beresniak A, Gossec L, Goupille P, et al. Direct cost-modeling of rheumatoid arthritis according to disease activity categories in France. J Rheumatol 2011; 38(3):439-45.

12. Huscher D, Mittendorf T, von Hinüber U, et al. Evolution of cost structures in rheumatoid arthritis over the past decade. Ann Rheum Dis 2015; 74(4):738-45.

13. Ahluwalia V, Frank C, Mosher D, et al. A pan-Canadian approach to inflammatory arthritis models of care. Arthritis Alliance of Canada 2014.

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