Work disability and productivity loss in patients with inflammatory bowel diseases in Hungary in the era of biologics.
OBJECTIVE
To assess work disability (WD) rates in an inflammatory bowel disease (IBD) cohort involving patients with Crohn's disease (CD) or ulcerative colitis (UC) cohort and to identify possible clinical or demographic factors associated with WD. To our knowledge, this is the first study from Eastern Europe that has estimated indirect costs in IBD.


METHODS
Data from 443 (M/F: 202/241, CD/UC: 260/183, mean age: 35.5 (CD) and 40.5 (UC) years, biological drug exposure 31.2/11.5%) consecutive patients were included. WD data were collected by questionnaire and the work productivity and activity impairment instrument. Disability pension (DP) rates in the general population were retrieved from public databases.


RESULTS
The overall DP rate in this IBD population was 32.3%, with partial disability in 24.2%. Of all DP events, 88.8% were directly related to IBD. Overall, full DP was more prevalent in IBD (RR: 1.51, p < 0.001) and CD (RR: 1.74, p < 0.001) but not in UC compared to the general population and also in CD compared to UC (OR 1.57, p = 0.03). RR for full DP was increased only in young CD patients (RR<35 year olds: 9.4; RR36-40 year olds: 9.4 and 5.6, p < 0.01 for both). In CD, age group, previous surgery, disease duration, frequent relapses, and the presence of arthritis/arthralgia were associated with an increased risk for DP. Among employed patients, absenteeism and presenteeism was reported in of 25.9 and 60.3% patients, respectively, leading to a 28% loss of work productivity and a 32% activity loss, and was associated with disease activity and age group. Average cost of productivity loss due to disability and sick leave with a human capital approach was 1,450 and 430 €/patient/year in IBD, respectively (total productivity loss 1,880 €/patient/year), the costs of presenteeism were 2,605 (SD = 2,770) and 2,410 (SD = 2,970) €/patient/year in CD and UC, respectively.


CONCLUSIONS
Risk of DP was highly increased in young CD patients (sixfold to ninefold). Previous surgery and presence of arthritis/arthralgia was identified as risk factors for DP. Work productivity is significantly impaired in IBD and is associated with high productivity loss.
Michael D
MD
Mandel
1st Department of Medicine, Semmelweis University, Korányi Sándor utca 2/A, 1083, Budapest, Hungary.
Mandel D
MD
Michael
Anita
A
Bálint
Barbara D
BD
Lovász
László
L
Gulácsi
Bálint
B
Strbák
Petra A
PA
Golovics
Klaudia
K
Farkas
Zsuzsanna
Z
Kürti
Blanka K
BK
Szilágyi
Anna
A
Mohás
Tamás
T
Molnár
Péter L
PL
Lakatos
D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D001685:Biological Factors / Q000627:therapeutic use*; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000191:economics*; D003424:Crohn Disease / Q000188:drug therapy / Q000191:economics*; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D006814:Hungary; D018868:Insurance, Disability; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D018582:Sick Leave / Q000191:economics* / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D055815:Young Adult
D001685:Biological Factors; D014409:Tumor Necrosis Factor-alpha