High Disease Burden Drives Indirect Costs in Employed Inflammatory Bowel Disease Patients: The WORK-IBD Study

Abstract

Background: Work productivity (WP) loss includes absence from work (absenteeism) and productivity loss while working (presenteeism), which leads to high indirect costs in inflammatory bowel disease (IBD). Prior health economic analyses predominantly focused on absenteeism. Here we focus on presenteeism and assess predictors of WP loss, fatigue, and reduced health-related quality of life (HRQL).

Methods: Employed IBD patients completed the following surveys: Work Productivity and Activity Impairment, Multidimensional Fatigue Inventory, and Short Inflammatory Bowel Disease Questionnaire. Predictors were assessed using uni- and multivariable regression analyses. Annual costs were calculated using percentages of WP loss, hourly wages, and contract hours.

Results: Out of 1590 invited patients, 768 (48%) responded and 510 (32%) were included. Absenteeism, presenteeism, and overall WP loss were reported by 94 (18%), 257 (50%), and 269 (53%) patients, respectively, resulting in mean (SD) annual costs of €1738 (5505), €5478 (8629), and €6597 (9987), respectively. Disease activity and active perianal disease were predictors of WP loss (odds ratio [OR] = 6.6; 95% confidence interval [CI], 3.6-12.1); OR = 3.7; 95% CI, 1.5-8.7). Disease activity and arthralgia were associated with fatigue (OR = 3.6; 95% CI, 1.9-6.8; OR = 1.8; 95% CI, 1.0-3.3)) and reduced HRQL (OR = 10.3; 95% CI, 5.9-17.9; OR = 2.3; 95 % CI, 1.4-3.8). Fatigue was the main reason for absenteeism (56%) and presenteeism (70%). Fatigue and reduced HRQL led to increased costs compared with absence of fatigue and normal HRQL (mean difference = €6630; 95% CI, €4977-€8283, P < 0.01; mean difference = €9575; 95% CI, €7767-€11,384, P < 0.01).

Conclusions: Disease activity and disease burden lead to WP loss in approximately half of the employed IBD population, driving indirect costs. Fatigue is the most important reason for WP loss.

Keywords: health economics; inflammatory bowel disease; work productivity.

FIGURE 1.

Flowchart of included and excluded patients.

FIGURE 2.

Percentage of patients with IBD with high disease burden. Group 1, immunomodulator- and biologic-naïve; Group 2, biologic-naïve; Group 3, first-class biologic; Group 4, second-class biologic; Group 5, third-class biologic.

FIGURE 3.

Patient-reported IBD-related reasons for WP loss. Patient-reported reasons for WP loss presented as percentages of the total number of patients who reported absenteeism or presenteeism. Patients could have answered with more than 1 response as a reason for their absenteeism or presenteeism. Other reasons included for absenteeism: recovery of recent bowel or fistula surgery, visit of reintegration coach, stoma leakage, CD-related trauma therapy psychologist, partial work disability, recovery after exacerbation, adverse effect of medical therapy used for complications of other IBD therapy, viral infection/illness and headache. Other reasons included for presenteeism: concentration problems, recovery after fistula surgery, physical limitations because of stoma (eg, heavy lifting), fistula, stoma leakage, frequent changing of stoma bag, sweating, urgency, headache, arthralgia, myalgia, aggravated tinnitus, CD-related trauma, partial work disability, adverse effect of medical therapy used for complications of other IBD therapy and visual impairment.

FIGURE 4.

Correlation of patient-reported outcomes. A, The SIBDQ score. Quality of life inversely correlated with WP loss (Spearman correlation coefficient = –0.632; P < 0.001). B, The MFI score. Fatigue significantly correlated with WP loss (Spearman correlation coefficient = 0.530; P < 0.001).

FIGURE 5.

Indirect costs (€) per patient per year because of overall WP loss. Grey box and error bars indicate mean and SD of indirect costs per treatment group, respectively. Group 1, immunomodulator- and biologic-naïve; Group 2, biologic-naïve; Group 3, first-class biologic; Group 4, second-class biologic; Group 5, third-class biologic.