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WORK PRODUCTIVITY LOSS DUE TO RHEUMATOID ARTHRITIS (RA),
CROHN’S DISEASE (CD) AND PSORIASIS (PS) IN POLAND
ISPOR 17th Annual European Congress
Wladysiuk M1, Bebrysz M2, Fedyna M2, Haldas M2, Rutkowski J2
Amsterdam, The Netherlands, November 8–12, 2014
1 – Central and Eastern European Society of Technology Assessment in Health Care, Krakow, Poland
2 – HTA Consulting, Krakow, Poland
PMS57
Introduction
Summary
The immune-mediated inflammatory diseases (IMIDs) influence physical
and mental state of the patients. Additionally, they affect greatly work
productivity, not only by eliminating patients in productive age from the
working population, but also influencing every-day work performance. The
productivity loss, which is significant from the individual’s perspective,
can also be measured globally as a loss of benefit for the whole society.
It could be expected that loss of productivity rises with severity of patient’s
condition. In case of autoimmune inflammatory diseases, it could be related
to the severity of the inflammation episode. That is why it is important
to control the intensity of episodes to minimize the productivity loss.
The analysis of total indirect cost of a disease should be an important
factor taken into consideration by health care policy makers. The aim of
this presentation was to demonstrate the total indirect costs of RA, CD
and Ps in an employed population in Poland and to show how differently
indirect costs (namely costs of absenteeism and presenteeism) can be
generated by each disease.
OBJECTIVES To assess the indirect costs of RA, CD and Ps in an employed population in Poland.
METHODS Data on presenteeism and absenteeism related with analyzed diagnoses were collected in a cross-sectional study from patients
of ambulatory specialist care around Poland (30 rheumatology, 30 dermatology and 29 gastroenterology centers). Lost productivity was
measured with Work Productivity and Activity Impairment (WPAI) questionnaire and patients’ disease activity was assessed on standardized,
disease specific scales (DAS28, PASI, and CDAI). 328 (RA), 460 (Ps), 256 (CD) working patients were included in the analyses conducted
separately for each diagnosis. Unit cost of lost productivity was estimated using 2012 GDP per worker per hour corrected for diminishing
marginal productivity and added up to EUR 8.12.
RESULTS Mean age of M2W respondents was 36 for CD, 42 for Ps and 46 for RA patients (only patients in productive age – 18‑60/65 were
included in the study). Ps patients had dominantly (54%) low disease activity, in RA group mostly (51%) the moderate activity was observed, while
the most frequent disease activity category for CD patients was remission (39%). Mean annual cost of overall work impairment (presenteeism
and absenteeism cost together) amounted to EUR 7 271 for RA, EUR 5 977 for Ps and EUR 5 793 for CD. Cost of loss of productivity due to
RA ranged from EUR 3 686 for patients in remission to EUR 10 101 for highly active disease. For Ps it was respectively EUR 3 387 and EUR
10 765 and for CD EUR 3 802 and EUR 15 599.
CONCLUSIONS Productivity loss among workers with CD, Ps and RA generates significant costs for society which rises with disease activity.
Methods
Data on presenteeism and absenteeism related with analyzed diagnoses
were collected in a cross-sectional, multicenter, observational Polish study
Move to Work. Patients in productive age (18-60 in case of women, 18-65 in
case of men) with diagnosis of rheumatoid arthritis (RA), psoriasis (Ps) and
Crohn’s disease (CD) from 30 ambulatory rheumatology, 30 dermatology
and 29 gastroenterology centers were invited to participate. Only the
rheumatology and dermatology centers which had signed contract on
ambulatory services with NHF were considered. The gastroenterology
specialist centers were selected among the facilities which participated in
the Polish Registry of Crohn’s disease, with the exception of facilities which
had registered less than 10 patients. Specialists included in the study were
rheumatologists, dermatologists and gastroenterologists (one from each
center) who have had minimum 5 years of experience and have consulted
at least 10 patients weekly.
The Move to Work study took place from 15th November 2012 till 15th
December 2012.
Loss of productivity was measured with a validated tool Work Productivity
and Activity Impairment (WPAI) questionnaire, allowing to compare the
productivity loss among the diseases. Patients’ disease activity was
assessed by practitioners using standardized, disease specific scales
(DAS28, PASI, and CDAI).
For all diseases under consideration, analyses for absenteeism,
presenteeism and overall work impairment rate were conducted.
Additionally, statistical analyses in sub-groups (created in relation to
disease activity - remission, low, moderate and high) were carried out.
These analyses were based on nonparametric Kruskal-Wallis test to find
any differences between independent samples (corresponding to subgroups). If the Kruskal-Wallis test prooved differences in sub-groups, then
the U-Mann-Withney test was performed for each pair (to establish which
of the analyzed sub-groups are responsible for the variability). Indirect
costs were calculated for each disease for absenteeism, presenteeism
and overall impairment separately, using GDP per worker per hour, which
was equal to 12.49 EUR. Human capital method was adopted. A correction
for diminishing marginal work productivity was applied (0.65). Statistical
significance was set on 5%.
The average euro exchange rate in 31 December 2012 was assumed on
the basis of the National Bank of Poland data (100 EUR = 408.82 PLN).
Figure 2.Annual indirect costs per person according to disease activity
Tabela 1.Patients’ characteristics
Total M2W
population
Parameter
N
Working
population
without missing
data (analyzed
population)
p < 0.01
N
CD
34.91
463
35.73
464
53.5%
256
CDAI result (mean)
192.15
442
182.27
246
Disease
activity
Low
25.1%
Moderate
33.5%
Severe
3.4%
8 000 EUR
255
52.4%
38.0%
14 000 EUR
10 000 EUR
Sex (% of men)
Remission
16 000 EUR
28.9%
28.9%
the amount of goods and services (work in this case) produced
within a country’s borders in a specific time period per one
worker. Indicator commonly used in the economy and relatively
easy in application. The law of dimishing marginal productivity of
production factors, which works in the economy, states that with
the increase of a single factor of production, with other production
factors staying constant, the decrease in marginal (incremental)
output of production is noticed. Therefore, adjustment of results
is needed (coefficient of 0.65 was applied).
Results
Characteristics of analyzed participants
From a total number of 2100 patients enrolled to M2W study, 1044 met
established criteria* (256 CD patients, 460 Ps patients and 328 RA patients)
and were analyzed for work productivity loss and indirect cost of mentioned
diseases. Mean age of analyzed WPAI respondents was 36 for CD, 46 for
RA and 42 for Ps patients (only patients in productive age – 18-60/65 were
included in the study). Mean age of total M2W population was similar (35,
48 and 42 respectively).
The average value of CDAI, measured in enrolled patients with
Crohn’s disease indicated low disease activity, but the most frequent
disease activity category for CD patients was remission (39% and 38%
respectively for population analyzed for productivity loss and total M2W
population). The average value of DAS28 measured in enrolled patients
with rheumatoid arthritis indicated moderate disease activity and in
RA patients mostly (51% and 55% respectively) the moderate activity
was observed. The average value of PASI, measured in enrolled patients
with psoriasis indicated low/moderate disease activity. Ps patients had
dominantly (54% and 52% respectively) low disease activity 9.8% of
patients with psoriasis were also affected by psoriatic arthritis.
Summary of patients’ characteristics (both for total M2W population and
analyzed population) are shown in Table 1. Worthy of note is the fact, that
for each illness average disease activity is lower in working population than
total population of the study. Greater number of patients from analyzed
population than from total M2W population was classified to groups indicating
remission or low disease activity. The opposite situation was observed for
groups of patients with moderate or high disease activity.
p < 0.001
p < 0.001
p < 0.001
p < 0.01
2 000 EUR
0 EUR
Remission
Low activity
Moderate activity
High activity
246
Absenteeism
Presenteeism
Overall work
impairment
1 252 EUR
1 359 EUR
3 940 EUR
13 224 EUR
2 550 EUR
3 339 EUR
4 001 EUR
2 375 EUR
3 802 EUR
4 718 EUR
7 997 EUR
15 599 EUR
3.3%
RA
Mean age
48.37
812
46.35
327
Sex (% of men)
24.6%
814
28.0%
328
DAS 28 result (mean)
4.24
803
4.10
323
Remission
Disease
activity
10.0%
Low
10.3%
Moderate
55.2%
Severe
RA
803
24.5%
13.9%
51.1%
6 000 EUR
4 000 EUR
323
819
42.15
459
Sex (% of men)
51.1%
822
52.8%
460
PASI result (mean)
10.73
818
10.26
457
Disease
activity
Moderate
29.8%
Severe
12.8%
5.7%
818
53.6%
28.4%
p < 0.001
p < 0.01
p < 0.01
p < 0.05
p < 0.05
p < 0.001
p < 0.01
p < 0.001
p < 0.05
0 EUR
42.29
52.1%
p < 0.001
2 000 EUR
Mean age
Low
14 000 EUR
8 000 EUR
22.9%
5.3%
p < 0.001
10 000 EUR
Remission
Low activity
Moderate activity
High activity
Ps
Remission
p < 0.001
16 000 EUR
12 000 EUR
12.1%
Ps
Absenteeism
Presenteeism
Overall work
impairment
1 248 EUR
1 044 EUR
3 188 EUR
5 564 EUR
2 405 EUR
3 702 EUR
4 318 EUR
4 400 EUR
3 686 EUR
4 795 EUR
7 564 EUR
10 101 EUR
16 000 EUR
p < 0.001
14 000 EUR
457
12 000 EUR
10 000 EUR
12.3%
8 000 EUR
Human capital approach GDP per worker
p < 0.001
4 000 EUR
6 000 EUR
method of measuring indirect costs of disease which assumes
that the loss of productivity continues during the patient’s lifetime
and includes all occasions in which someone’s work potential is
limited by the disease, such as loss of productivity at workplace
(i.e. presentheeism), absence due to employee’s disease
(i.e. absenteeism), permanent disability and death. In the M2W
study estimation of loss of productivity was based on presenteeism
and absenteeism.
p < 0.001
6 000 EUR
39.0%
442
p < 0.001
p < 0.001
12 000 EUR
CD
Mean age
p < 0.001
p < 0.01
p < 0.001
p < 0.001
p < 0.001
p < 0.001
p < 0.01
p < 0.01
p < 0.05
p < 0.001
p < 0.05
4 000 EUR
2 000 EUR
0 EUR
Indirect costs of diseases
According to results of M2W study, annual indirect costs per working person
associated with overall work impairment due to analyzed illnesses varied
from 5.8 thousand EUR (CD) to 7.2 thousand EUR (RA). Annual indirect costs
per working person associated with absenteeism varied from 1.6 thousand
EUR (Ps) and 3.2 thousand EUR (RA) and indirect costs associated with
presenteeism – from 3.2 thousand EUR (CD) and 4.4 thousand EUR (Ps).
It should be noticed that studied sample of CD patients had a rather low
disease activity. This could be the reason of moderate indirect costs of CD
despite the fact that CD symptoms in general are considered rather severe.
However, costs of work productivity loss for patients with highly active CD
were higher than for patients with highly active RA or psoriasis.
Costs associated with presenteeism for patients with psoriasis are more than
two times higher than corresponding costs associated with absenteeism
(4.4 and 1.6 thousand EUR respectively). In other diseases absenteeism
and presenteeism costs are similar (presenteeism costs are slightly higher
in each case).
Detailed values for indirect costs of analyzed diseases are presented in
Figure 1.
Analyzed diseases influence work ability in different ways – psoriasis caused
the highest presenteeism, significant at every disease activity level, probably
because its symptoms were highly distracting, but weren’t severe enough
to cause a lot of absenteeism. In case of CD and RA the absenteeism and
presenteeism seemed to be equally significant. It could be noticed that
absenteeism costs increase faster with higher disease activity than costs
associated with presenteeism.
Annual indirect costs per working person with CD associated with overall
work impairment rise with disease activity from 3.8 (remission) to 15.6 (high
disease activity) thousand EUR. For patients with RA these costs rise from
3.7 to 10.1 thousand EUR respectively and for Ps patients – from 3.4 to
10.8 thousand EUR respectively.
Figure 1.Annual indirect costs of diseases (per person) associated with
productivity loss
8 000 EUR
7 000 EUR
5 000 EUR
4 000 EUR
3 000 EUR
2 000 EUR
1 000 EUR
Absenteeism
Presenteeism
Overall work impairment
Presenteeism
Overall work
impairment
277 EUR
549 EUR
2 132 EUR
5 418 EUR
3 110 EUR
4 067 EUR
4 850 EUR
5 347 EUR
3 387 EUR
4 616 EUR
6 999 EUR
10 765 EUR
Conclusions
The highest annual indirect costs per working person associated with
both absenteeism and overall work impairment are generated by
patients with RA. The highest annual indirect costs per working person
associated with presenteeism are generated by patients with Ps.
The lowest annual indirect costs per working person associated
with absenteeism are generated by patients with Ps. The lowest
annual indirect costs per working person associated with both
presenteeism and overall work impairment are generated by
patients with CD.
Productivity loss among workers with CD, Ps and RA generates
significant costs for society which rise with disease activity.
Absenteeism costs increase faster with higher disease activity
than costs associated with presenteeism.
Limitations
Absenteeism rates were calculated more objectively than presenteeism
rates – parameters from the first group were measured by the number
of working hours lost because of the illness. Presenteeism rates were
assessed by questionnaire and answers could have been subjective
(although there is no better way to assess presenteeism rate).
Only patients undergoing outpatient visits were included in the study.
However, it seems that a significant proportion of people suffering from
analyzed diseases in Poland is treated in hospitals or is not treated at all
(e.g. Ps patients with low disease activity). Data on these groups were
not collected.
6 000 EUR
0 EUR
Remission
Low activity
Moderate activity
High activity
Absenteeism
CD
2 547 EUR
3 226 EUR
5 793 EUR
RA
3 161 EUR
4 036 EUR
7 271 EUR
Ps
1 570 EUR
4 403 EUR
5 977 EUR
The character of WPAI questions makes the WPAI questionnaire rather
incompatible with the professional activity without determined work timeschedule (such as self-employed or product-oriented contracts). It may
have been a cause of inaccuracy in results of the loss of productivity
analysis for certain types of employment (e.g. farmers) and – in
consequence – the indirect costs analysis.
* Working patients without missing data in WPAI questionnaire.
Central and Eastern European Society
of Technology Assessment in Health Care