Impact of Cervical Dystonia on Work Productivity: An Analysis From a Patient Registry

Abstract

Background: Cervical dystonia is thought to result in high disease burden, but limited information exists on its impact on employment and work productivity. We utilized data from the Cervical Dystonia Patient Registry for the Observation of OnabotulinumtoxinA Efficacy (ClinicalTrials.gov identifier: NCT00836017) to assess the impact of cervical dystonia on employment and work productivity and examine the effect of onabotulinumtoxinA treatments on work productivity.

Methods: Subjects completed a questionnaire on employment status and work productivity at baseline and final visit. Baseline data were examined by severity of cervical dystonia, predominant subtype, presence of pain, prior exposure to botulinum toxin, and/or utility of a sensory trick. Work productivity results at baseline and final visit were compared in subjects who were toxin-naïve at baseline and received three onabotulinumtoxinA treatments.

Results: Of 1,038 subjects, 42.8% were employed full- or part-time, 6.1% unemployed, 32.7% retired, and 11.8% disabled. Of those currently employed, cervical dystonia affected work status of 26.0%, caused 29.8% to miss work in the past month (mean, 5.1 ± 6.4 days), and 57.8% reported decreased productivity. Half of those unemployed were employed when symptoms began, and 38.5% attributed lost employment to cervical dystonia. Pain, increasing severity, and anterocollis/retrocollis had the largest effects on work status/productivity. Preliminary analyses showed that absenteeism and presenteeism were significantly decreased following onabotulinumtoxinA treatments in the subpopulation that was toxin-naïve at baseline.

Conclusions: This analysis confirms the substantial negative impact of cervical dystonia on employment, with cervical dystonia-associated pain being a particularly important driver. OnabotulinumtoxinA treatment appears to improve work productivity.

Keywords: botulinum toxin; cervical dystonia; employment.

Figure 1

(A) Baseline work status, absenteeism, and productivity in CD PROBE subjects who were currently employed at baseline and (B) baseline effect of CD on employment in subjects not currently employed at baseline, both in the as‐treated baseline population that had ever been employed (N = 1,000).

Figure 2

Employment by age and gender in the CD PROBE and 2009–2012 U.S. populations. For the CD PROBE population, responses of full‐time, part‐time, self‐employed, and other were considered employed, with the number employed indicated within the bars. General population values were from the U.S. Bureau of Labor and Statistics employment population ratio (weighted based on years of recruitment for CD PROBE).

Figure 3

For the population that was toxin‐naïve at baseline, (A) baseline work status, absenteeism, and productivity in subjects who were employed at baseline, (B) final work status, absenteeism, and productivity in subjects who were employed at baseline, (C) baseline effect of CD on employment in subjects not currently employed at baseline, and (D) final effect of CD on employment in subjects not currently employed at baseline. SD, standard deviation.