title: The economic impact of GERD and PUD: examination of direct and indirect costs using a large integrated employer claims database.
abstract: OBJECTIVE
  The objective of this study was to examine the relationship of work loss associated with gastro- the relationship of work loss associated with gastro- the relationship of work loss associated with gastro-esophageal reflux disease (GERD) and peptic ulcer disease (GERD) and peptic ulcer disease (PUD) in a large population of employed individuals in the United States (US) and quantify the individuals in the United States (US) and quantify the economic impact of these diseases to the employer.
  
  
  METHODS
  A proprietary database that contained work place absence, disability and workers' compensation data in addition to prescription drug and medical claims was used to answer the objectives. Employees with a medical claim with an ICD-9 code for GERD or PUD were identified from 1 January 1997 to 31 December 2000. A cohort of controls was identified for the same time period using the method of frequency matching on age, gender, industry type, occupational status, and employment status. Work absence rates and health care costs were compared between the groups after adjusting for demo graphic, and employment differences using analysis of covariance models.
  
  
  RESULTS
  There were significantly lower (p < 0.05) prescription, and outpatient costs in the controls compared to the disease groups, although the eta-square values were very low. The mean work absence attributed to sick days was 2.8 (+/- 2.3) for controls, 3.4 (+/- 2.5) for GERD, 3.2 (+/- 2.6) for PUD, and 3.2 (+/- 2.3) days for GERD + PUD. For work loss, a significantly higher (p < 0.05) rate of adjusted all-cause absenteeism and sickness-related absenteeism were observed between the disease groups versus the controls. In particular, controls had an average of 1.2 to 1.6 days and 0.4 to 0.6 lower all-cause and sickness-related absenteeism compared to the disease groups. The incremental economic impact projected to a hypothetical employed population was estimated to be $3441 for GERD, $1374 for PUD, and $4803 for GERD + PUD per employee per year compared to employees without these diseases.
  
  
  CONCLUSIONS
  Direct medical cost and work absence in employees with GERD, PUD and GERD + PUD represent a significant burden to employees and employers.
authors.affiliation: Pharmacotherapy Outcomes Research Center, University of Utah College of Pharmacy, Salt Lake City, UT, USA.
authors.forename: Vijay N
authors.initials: VN
authors.lastname: Joish
authors.forename: Gary
authors.initials: G
authors.lastname: Donaldson
authors.forename: William
authors.initials: W
authors.lastname: Stockdale
authors.forename: Gary M
authors.initials: GM
authors.lastname: Oderda
authors.forename: Joseph
authors.initials: J
authors.lastname: Crawley
authors.forename: Rahul
authors.initials: R
authors.lastname: Sasane
authors.forename: Sandra
authors.initials: S
authors.lastname: Joshua-Gotlib
authors.forename: Diana I
authors.initials: DI
authors.lastname: Brixner
mesh_terms: D000041:Absenteeism; D000328:Adult; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000191:economics* / Q000628:therapy; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009790:Occupations; D010437:Peptic Ulcer / Q000150:complications / Q000191:economics* / Q000628:therapy; D012189:Retrospective Studies; D014481:United States; D014942:Workers' Compensation / Q000191:economics* / Q000706:statistics & numerical data*; D017132:Workplace