title: Productivity costs and determinants of productivity in HIV-infected patients.
abstract: BACKGROUND
  In HIV-infected patients, reduced ability to work may be an important component of the societal costs of this disease. Few data about productivity costs in HIV-infected patients are available.
  
  
  OBJECTIVE
  The goals of this study were to estimate productivity costs in the HIV-infected population in Switzerland and to identify characteristics that may influence patient productivity.
  
  
  METHODS
  This cross-sectional study included all patients younger than retirement age (65 years for men and 62 years for women) who were enrolled in the Swiss HIV Cohort Study in 2002. Measures of productivity losses in this population were based on patients' ability to work and the median monthly wage rates adjusted for age, sex, and educational level in Switzerland. Factors associated with ability to work were analyzed in a multivariate ordinary logistic regression (proportional odds) model. As of July 1, 2002, the exchange rate for US dollars to Swiss francs (CHF) was US $1.00 approximately equal to CHF 1.48.
  
  
  RESULTS
  A total of 5319 HIV-infected patients (3665 men [68.9%] and 1655 women [31.1%]; mean [SD] age, 40.6 [8.4] years; range, 17-64 years) were included in the study. The mean annual productivity loss per patient was estimated at CHF 22,910 (95% CI, CHF 22,064-CHF 23, 756). Ability to work was independently associated with the following (P < 0.001 for all): age (10-year increase: odds ratio [OR], 0.60 [95% CI, 0.54-0.62]), sex (female/male: OR, 0.73 [95% CI, 0.63-0.84]), history of IV drug use (OR, 0.22 [95% CI, 0.19-0.26]), time since first positive HIV test (>10 years vs < or = 10 years: OR, 0.66 [95% CI, 0.58-0.76]), CD4 cell count (201-500 vs 0-200 cells/microL: OR, 1.68 [95% CI, 1.38-2.46]; > or =501 vs 0-200 cells/microL: OR, 2.01 [95%, CI, 1.64-2.46]), history of AIDS-indicator disease (OR, 0.47 [95% CI, 0.41-0.55]), stable partnership during the last 6 months (OR, 1.63 [95% CI, 1.43-1.86]), and educational level (higher vs basic: OR, 1.68 [95% CI, 1.45-1.95]).
  
  
  CONCLUSIONS
  Productivity losses to society for the HIV-infected population appeared to be substantial in this analysis. Given a patient's clinical health status, a higher education level and a stable partnership were associated with greater ability to work. Socioeconomic characteristics may influence the cost-effectiveness of health care interventions in HIV-infected patients.
authors.affiliation: Division of Infectious Diseases, Basel University Hospital, Basel, Switzerland.
authors.forename: Pedram
authors.initials: P
authors.lastname: Sendi
authors.forename: Fabian
authors.initials: F
authors.lastname: Schellenberg
authors.forename: Chaiwat
authors.initials: C
authors.lastname: Ungsedhapand
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Kaufmann
authors.forename: Heiner C
authors.initials: HC
authors.lastname: Bucher
authors.forename: Rainer
authors.initials: R
authors.lastname: Weber
authors.forename: Manuel
authors.initials: M
authors.lastname: Battegay
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D004526:Efficiency; D005260:Female; D015658:HIV Infections / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D013557:Switzerland