title: Sick leave and disability pension in inflammatory bowel disease: a systematic review.
abstract: OBJECTIVE
  Inflammatory bowel disease has considerable effects on work-related outcomes and leads to high societal costs due to sick leave and disability pension. The aims of this study were to systematically review evidence on work-related outcomes that are relevant to productivity losses and to evaluate whether medical or surgical interventions have a positive impact on patients' work ability.
  
  
  METHODS
  A systematic literature search in PubMed was conducted in June 2013. Abstracts were screened by two independent reviewers, and full-text articles describing the frequency of work-related outcomes were retrieved. Two independent reviewers extracted data according to the PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses. Findings were organized by study design (non-interventional/interventional). Non-interventional studies were structured according to whether they presented data in comparison to control groups or not and interventional studies were summarized according to type of intervention.
  
  
  RESULTS
  This review included 30 non-interventional (15 with comparison groups and 15 without comparison group) and 17 interventional studies (9 surgical and 8 medical). The majority of the studies reported a high burden of work-related outcomes among inflammatory bowel disease patients regardless of the methodology used. While biologic agents showed positive effect on work absenteeism and presenteeism in randomized clinical trials, the impact of surgical interventions needs further evaluation.
  
  
  CONCLUSIONS
  Inflammatory bowel disease patients experience a high burden in work-related outcomes. Additional data on productivity losses and the long-term impact of interventions is needed to help inform decision-makers about treatment options and their benefits in reducing productivity losses in inflammatory bowel disease patients.
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden. Electronic address: katharina.busch@ki.se.
authors.forename: Katharina
authors.initials: K
authors.lastname: Büsch
authors.affiliation: Department of Preventive Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Simone A
authors.initials: SA
authors.lastname: da Silva
authors.affiliation: Lorimer Enterprises Inc., Red Deer, Alberta, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Holton
authors.affiliation: Department of Preventive Medicine, University of São Paulo, São Paulo, Brazil.
authors.forename: Fabiana M
authors.initials: FM
authors.lastname: Rabacow
authors.affiliation: Digestive Healthcare Center, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Hamed
authors.initials: H
authors.lastname: Khalili
authors.affiliation: Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden.
authors.forename: Jonas F
authors.initials: JF
authors.lastname: Ludvigsson
mesh_terms: D000041:Absenteeism; D003093:Colitis, Ulcerative / Q000628:therapy*; D017281:Cost of Illness; D003424:Crohn Disease / Q000628:therapy*; D004185:Disability Evaluation; D004526:Efficiency; D004651:Employment; D006801:Humans; D010415:Pensions; D012179:Retirement; D018582:Sick Leave
keywords: Crohn's disease; Review; Ulcerative colitis; Work outcomes