RT Journal Article
SR Electronic
T1 The financial burden of accessing care for people with scleroderma in Canada: a patient-oriented, cross-sectional survey
JF CMAJ Open
JO CMAJ
FD Canadian Medical Association
SP E630
OP E636
DO 10.9778/cmajo.20220227
VO 11
IS 4
A1 Trenaman, Logan
A1 Kaal, K. Julia
A1 Laba, Tracey-Lea
A1 Safari, Abdollah
A1 Aguiar, Magda
A1 Burch, Tiasha
A1 Beckett, Jennifer
A1 Munro, Sarah
A1 Hudson, Marie
A1 Harrison, Mark
YR 2023
UL http://www.cmajopen.ca/content/11/4/E630.abstract
AB 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.