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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