title: Effect of adalimumab on work productivity and indirect costs in moderate to severe Crohn's disease: a meta-analysis.
abstract: OBJECTIVE
  To assess the effect of adalimumab on work productivity and indirect costs in patients with Crohn's disease (CD) using a meta-analysis of clinical trials.
  
  
  METHODS
  Study-level results were pooled from all clinical trials of adalimumab for moderate to severe CD in which work productivity outcomes were evaluated. Work Productivity and Activity Impairment Questionnaire outcomes (absenteeism, presenteeism and total work productivity impairment [TWPI]) were extracted from adalimumab trials. Meta-analyses were used to estimate pooled averages and 95% CIs of one-year accumulated reductions in work productivity impairment with adalimumab. Pooled averages were multiplied by the 2008 United States national average annual salary ($44,101) to estimate per-patient indirect cost savings during the year following adalimumab initiation.
  
  
  RESULTS
  The four included trials (ACCESS, CARE, CHOICE and EXTEND) represented a total of 1202 employed adalimumab-treated patients at baseline. Each study followed patients for a minimum of 20 weeks. Pooled estimates (95% CIs) of one-year accumulated work productivity improvements were as follows: -9% (-10% to -7%) for absenteeism; -22% (-26% to -18%) for presenteeism; and -25% (-30% to -20%) for TWPI. Reductions in absenteeism and TWPI translated into per-patient indirect cost savings (95% CI) of $3,856 ($3,183 to $4,529) and $10,964 ($8,833 to $13,096), respectively.
  
  
  CONCLUSIONS
  Adalimumab provided clinically meaningful improvements in work productivity among patients with moderate to severe CD, which may translate into substantial indirect cost savings from an employer's perspective.
authors.affiliation: Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pennsylvania 15213, USA. binionpitt.edu
authors.forename: David G
authors.initials: DG
authors.lastname: Binion
authors.forename: Edouard
authors.initials: E
authors.lastname: Louis
authors.forename: Bas
authors.initials: B
authors.lastname: Oldenburg
authors.forename: Parvez
authors.initials: P
authors.lastname: Mulani
authors.forename: Arielle G
authors.initials: AG
authors.lastname: Bensimon
authors.forename: Mei
authors.initials: M
authors.lastname: Yang
authors.forename: Jingdong
authors.initials: J
authors.lastname: Chao
mesh_terms: D000041:Absenteeism; D000068879:Adalimumab; D000893:Anti-Inflammatory Agents / Q000191:economics* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics* / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D017281:Cost of Illness; D003424:Crohn Disease / Q000188:drug therapy* / Q000191:economics; D004526:Efficiency; D006801:Humans; D014937:Work / Q000191:economics
chemical_list: D000893:Anti-Inflammatory Agents; D061067:Antibodies, Monoclonal, Humanized; D000068879:Adalimumab