title: Presenteeism in Inflammatory Bowel Diseases: A Hidden Problem with Significant Economic Impact.
abstract: BACKGROUND
  Indirect costs associated with impaired productivity at work (presenteeism) due to inflammatory bowel disease (IBD) are a major contributor to health expenditures. Studies estimating indirect costs in the United States did not take presenteeism into account. We aimed to quantify work limitations and presenteeism and its associated costs in an IBD population to generate recommendations to reduce presenteeism and decrease indirect costs.
  
  
  METHODS
  We performed a prospective study at a tertiary IBD center. During clinic visits, work productivity, work-related problems and adjustments, quality of life, and disease activity were assessed in patients with IBD. Work productivity and impairment were assessed in a control population as well. Indirect costs associated with lost work hours (absenteeism) and presenteeism were estimated, as well as the effect of disease activity on those costs.
  
  
  RESULTS
  Of the 440 included patients with IBD, 35.6% were unemployed. Significantly more presenteeism was detected in patients with IBD (62.9%) compared with controls (27.3%) (P = 0.004), with no significant differences in absenteeism. Patients in remission experienced significantly more presenteeism than controls (54.7% versus 27.3%, respectively, P < 0.01), and indirect costs were significantly higher for remissive patients versus controls ($17,766 per yr versus $9179 per yr, respectively, P < 0.03). Only 34.3% had made adjustments to battle work-related problems such as fatigue, irritability, and decreased motivation.
  
  
  CONCLUSIONS
  Patients with IBD in clinical remission still cope with significantly more presenteeism and work limitations than controls; this translates in higher indirect costs and decreased quality of life. The majority have not made any adjustments to battle these problems.
authors.affiliation: *UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and †Center for Inflammatory Bowel Diseases, Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
authors.forename: Aria
authors.initials: A
authors.lastname: Zand
authors.forename: Welmoed K
authors.initials: WK
authors.lastname: van Deen
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Inserra
authors.forename: Laurin
authors.initials: L
authors.lastname: Hall
authors.forename: Ellen
authors.initials: E
authors.lastname: Kane
authors.forename: Adriana
authors.initials: A
authors.lastname: Centeno
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Choi
authors.forename: Christina Y
authors.initials: CY
authors.lastname: Ha
authors.forename: Eric
authors.initials: E
authors.lastname: Esrailian
authors.forename: Geert R
authors.initials: GR
authors.lastname: DʼHaens
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Hommes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000191:economics*; D008297:Male; D008875:Middle Aged; D000069597:Presenteeism / Q000191:economics*; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires; D055815:Young Adult