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. 2020 Mar 10:12:273-285.
doi: 10.2147/CLEP.S244011. eCollection 2020.

Work Loss in Relation to Pharmacological and Surgical Treatment for Crohn's Disease: A Population-Based Cohort Study

Åsa H Everhov  1   2 , Michael C Sachs  2 , Jonas F Ludvigsson  3   4 , Hamed Khalili  2   5 , Johan Askling  2 , Martin Neovius  2 , Pär Myrelid  6   7 , Jonas Halfvarson  8 , Caroline Nordenvall  9   10 , Jonas Söderling  2 , Ola Olén  1   2   11 ; SWIBREG study group
Affiliations

Work Loss in Relation to Pharmacological and Surgical Treatment for Crohn's Disease: A Population-Based Cohort Study

Åsa H Everhov et al. Clin Epidemiol. .

Abstract

Purpose: Patients with Crohn's disease have increased work loss. We aimed to describe changes in work ability in relation to pharmacological and surgical treatments.

Patients and methods: We linked data from the Swedish National Patient Register, The Swedish Quality Register for Inflammatory Bowel Disease SWIBREG, The Prescribed Drug Register, The Longitudinal Integrated Database for Health Insurance and Labour Market Studies, and the Social Insurance Database. We identified working-age (19-59 years) patients with incident Crohn's disease 2006-2013 and population comparator subjects matched by sex, birth year, region, and education level. We assessed the number of lost workdays due to sick leave and disability pension before and after treatments.

Results: Of 3956 patients (median age 34 years, 51% women), 39% were treated with aminosalicylates, 52% with immunomodulators, 22% with TNF inhibitors, and 18% with intestinal surgery during a median follow-up of 5.3 years. Most patients had no work loss during the study period (median=0 days). For all treatments, the mean number of lost workdays increased during the months before treatment initiation, peaked during the first month of treatment and decreased thereafter, and was heavily influenced by sociodemographic factors and amount of work loss before first Crohn's disease diagnosis. The mean increase in work loss days compared to pre-therapeutic level was ~3 days during the first month of treatment for all pharmacological therapies and 11 days for intestinal surgery. Three months after treatment initiation, 88% of patients treated surgically and 90-92% of patients treated pharmacologically had the same amount of work loss as before treatment start. Median time to return to work was 2 months for all treatments.

Conclusion: In this regular clinical setting, patients treated surgically had more lost workdays than patients treated pharmacologically, but return to work was similar between all treatments.

Keywords: TNF inhibitor; aminosalicylate; disability pension; immunomodulator; inflammatory bowel disease; sick leave.

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Conflict of interest statement

Å H Everhov and J Söderling have worked on projects at Karolinska Institutet and SWIBREG partly financed by grants from Ferring and Jansen. JF Ludvigsson coordinates a study on behalf of the Swedish IBD quality register (SWIBREG), which has received funding from Jansen corporation. O Olén has been PI on projects at Karolinska Institutet, partly financed by investigator-initiated grants from Janssen and Ferring, and Karolinska Institutet has received fees for lectures and participation on advisory boards from Janssen, Ferring, Takeda, and Pfizer. O Olén also reports a grant from Pfizer in the context of a national safety monitoring program. H Khalili has received grant funding from Pfizer and Takeda. P Myrelid has received lecturing fees from Ferring, Takeda, Abbvie and Vifor Pharma and been active in research with non-restricted grants from Pfizer, Janssen, Takeda and MSD. J Halfvarson has received personal fees as speaker, consultant and/or advisory board member for AbbVie, Aqilion AB, Celgene, Celltrion, Dr. Falk Pharma and the Falk Foundation, Ferring, Hospira, Janssen, MEDA, Medivir, MSD, Olink Proteomics, Pfizer, Prometheus Laboratories, Sandoz/Novartis, Shire, Takeda, Thermo Fisher Scientific, Tillotts Pharma, Vifor Pharma, UCB and received grant support from Janssen, MSD, and Takeda. J Askling reports grants from Abbvie, BMS, Eli Lilly, MSD, Pfizer, Roche, Samsung Bioepis, Sanofi, UCB, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Mean number of lost workdays per month in patients with Crohn’s disease from 6 months before to 18 months after start of treatment with aminosalicylate, immunomodulator, first and second line TNF inhibitor, and intestinal surgery, with and without censoring at addition of other treatment, or surgery.
Figure 2
Figure 2
Mean number of lost workdays per year in patients with Crohn’s disease from 5 years before to 5 years after first aminosalicylate, immunomodulator, TNF inhibitor, and intestinal surgery, with and without censoring at addition of other treatment, or surgery.
Figure 3
Figure 3
Proportion (left y-axis) with lost workdays per month from 3 months before to 6 months after first aminosalicylate, immunomodulator, TNF inhibitor, and intestinal surgery in patients with Crohn’s disease. The dashed line shows the 75th percentile, and the line the 90th percentile of lost workdays per month (right y-axis).
Figure 4
Figure 4
Mean number of lost workdays per month from 6 months before to 18 months after start of treatment with aminosalicylate, immunomodulator, TNF inhibitor, and intestinal surgery, stratified by mean number of lost workdays per month during the 2 years before first Crohn’s disease diagnosis.
Figure 5
Figure 5
Change in lost workdays per month from pre-treatment level (6 months before treatment initiation) in patients treated with aminosalicylate, immunomodulator, TNF inhibitor, and intestinal surgery. Dotted lines are pointwise 95% confidence intervals for the mean change.
See this image and copyright information in PMC

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