title: Health-Related Quality of Life Impairment and Indirect Cost of Crohn's Disease: A Self-Report Study in Poland.
abstract: OBJECTIVE
  Evidence on indirect cost of Crohn's disease (CD) is available but typically provides information on the loss of productivity at paid work of patients. In the present study, the quality of life and indirect costs of CD patients were assessed (overall and by disease severity).
  
  
  METHODS
  A self-report questionnaire-based study among adult Polish patients with CD was performed. We collected data on patients' characteristics, quality of life, loss of productivity, consumption of medical resources, and out-of-pocket expenses. The disease severity was determined using the patient's version of the Harvey-Bradshaw index. Productivity costs were assessed from the social perspective, using a human capital approach. The cost of absenteeism, presenteeism and permanent work disability was valuated using the gross domestic product per worker. The patients' productivity loss at unpaid work was measured by time inputs of others to assist patients. The productivity loss among informal caregivers and patients' productivity loss at unpaid work were valuated with the average wage in Poland. The results were adjusted for confounders.
  
  
  RESULTS
  The responses from 200 patients (47% in remission) were analysed. The mean utility index was 0.839 (SD 0.171). The total indirect cost was estimated at €462.47 per patient per month (24.0%, absenteeism; 35.0%, work disability; 30.4%, presenteeism; 0.4%, productivity loss at unpaid work; and 10.4%, informal care). A significant correlation of the quality of life and productivity losses with disease severity was observed. Compared with active disease, the remission subgroup had a higher utility index by 16% (p<0.001) and lower indirect costs by 71% (p = 0.003) for absenteeism, 41% (p = 0.030) for presenteeism, 76% (p<0.001) for productivity loss at unpaid work, and 75% (p<0.001) for informal care.
  
  
  CONCLUSIONS
  Our study revealed the social burden of CD and high dependency of indirect costs and quality of life on the severity of CD in Poland.
authors.affiliation: Drug Management Department, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Przemysław
authors.identifier: http://orcid.org/0000-0002-6821-4078
authors.initials: P
authors.lastname: Holko
authors.affiliation: Drug Management Department, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Kawalec
authors.affiliation: Polish Association Supporting People with Inflammatory Bowel Disease "J-elita", Warsaw, Poland.|International Institute of Molecular and Cell Biology, Warsaw, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Mossakowska
authors.affiliation: Department of Neurobiology, Polish Academy of Sciences, Krakow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pilc
mesh_terms: D000041:Absenteeism; D000328:Adult; D017281:Cost of Illness; D003424:Crohn Disease / Q000191:economics* / Q000523:psychology*; D004526:Efficiency; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011044:Poland; D011788:Quality of Life / Q000523:psychology*; D057566:Self Report; D018582:Sick Leave; D055815:Young Adult