A multinational assessment of work-related productivity loss and indirect costs from a survey of patients with psoriasis

Abstract

Background: Total work productivity loss (WPL) and associated indirect costs contribute to the economic burden of psoriasis.

Objectives: To estimate total WPL and related indirect costs, and identify predictors of WPL associated with psoriasis severity in France, Germany, Spain, the U.K. and Italy (EU5) and the U.S.A.

Methods: Data from the 2015 Adelphi Real World Psoriasis Disease Specific Programme, analysed for absenteeism, presenteeism and total WPL, were quantified (0-100%) from participants who completed the Work Productivity and Activity Impairment (WPAI) instrument. These measures were converted to indirect costs using the human capital method. Univariate and multivariate statistical analyses controlling for patient demographic and clinical characteristics were conducted.

Results: Of the 936 respondents (29·6% U.S.A., 70·4% EU5) who completed the WPAI, 32·6%, 40·7% and 26·6% had mild [body surface area (BSA) 0-2%], moderate (BSA 3-10%) and severe (BSA > 10%) psoriasis, respectively. Average age, Dermatology Life Quality Index (DLQI) score and BSA were, respectively, 42·4 years, 5·1 and 9·6%; and 37·2% of respondents were female. Mean percentages of total WPL for respondents with mild, moderate and severe psoriasis were 10·1%, 18·9% and 29·4%, respectively. Presenteeism contributed considerably more to total WPL than did absenteeism across all countries and disease severity classes. Mean annual indirect costs per patient due to WPL ranged from 3742 U.S. dollars in Spain to 9591 U.S. dollars in the U.S.A. Multivariate regression showed that a one-unit increase in DLQI score increases total WPL by 1·8% (P < 0·001).

Conclusions: WPL increased progressively with increasing DLQI scores and BSA, confirming the relationship between psoriasis severity and its economic burden. What's already known about this topic? The economic burden of psoriasis is exceptionally high given the high prevalence and lifelong nature of the condition. Several studies have attempted to assess the overall economic burden of psoriasis but there is a lack of comparative data from different countries, and issues around inconsistent methodologies, including statistical analyses. Total work productivity loss (WPL) and associated indirect costs are believed to contribute to the economic burden of psoriasis. What does this study add? This study measured total WPL and indirect costs via the same method and at the same time point in the U.S.A., France, Germany, Spain, U.K. and Italy. Total WPL increased progressively with psoriasis disease severity. Disease severity and Dermatology Life Quality Index scores significantly correlated with WPL after controlling for patient demographic and clinical characteristics. The U.S.A. had the highest annual mean indirect costs associated with total WPL. Linked Comment: Drabo et al. Br J Dermatol 2020; 183:420-421.

Figure 1

Sample flow diagram indicating how patients were selected for inclusion in the analysis. PSC, patient self‐completed; GDP, gross domestic product; DEU, Germany; ESP, Spain; FRA, France; ITA, Italy.

Figure 2

Percentage of work hours lost and annual indirect costs per patient due to absenteeism, presenteeism and total work productivity loss (WPL) by severity of psoriasis. (a) Percentage of work hours lost due to absenteeism and presenteeism and total WPL by severity of psoriasis for the pooled respondents; (b) annual indirect costs per patient associated with absenteeism, presenteeism and total WPL by severity of psoriasis for the pooled respondents. Pooled analysis of 936 respondents, where 32·6%, 40·7% and 26·6% of all respondents had psoriasis severities defined as mild body surface area (BSA) (0–2%), moderate BSA (3–10%) and severe BSA (>10%), respectively. Error bars indicate 95% confidence interval. USD, U.S. dollars.

Figure 3

Percentage of work hours lost and annual indirect costs per patient due to absenteeism, presenteeism and total work productivity loss (WPL) by country. (a) Percentage of work hours lost due to absenteeism and presenteeism and total WPL analysed by country; (b) annual indirect costs per patient associated with absenteeism, presenteeism and total WPL analysed by country. Analysis includes 277 respondents from the U.S.A., 185 from Germany (DEU), 157 from Spain (ESP), 150 from France (FRA), 138 from Italy (ITA) and 29 from the U.K. Error bars indicate 95% confidence interval. USD, U.S. dollars.

Figure 4

Predicted mean absenteeism, presenteeism and total work productivity loss relative to Dermatology Life Quality Index (DLQI) score. Impact of increasing DLQI score on predicted mean absenteeism (a), presenteeism (b) and total work productivity loss (c). Error bars indicate standard error of the mean. DLQI, Dermatology Life Quality Index.