11Rheumatoid arthritis and work: The impact of rheumatoid arthritis on absenteeism and presenteeism
Section snippets
Background
In patients with rheumatoid arthritis (RA), problems at work and loss of work may cause socio-economic consequences not only for the patient and their family and the employer but also for the society. For many patients with RA, work is an important part of their life, and being employed increases self-esteem, sense of purpose and financial independence. For employers supporting employees with a chronic disease such as RA, retaining experienced personnel may be more cost-effective than replacing
Absenteeism and presenteeism
Work productivity can be referred to as the economic productivity of a workplace. It is associated with input, costs, outputs and profits, but it is also dependent upon the quality/quantity and effectiveness of each individual employee (worker productivity) [1]. Workers who have not been lost to the workforce can be less productive as a result of absenteeism and presenteeism. Absenteeism, presenteeism and job loss are interrelated and codependent. For example, rates of presenteeism may be
Instruments to measure absenteeism and presenteeism
A number of questionnaires have been developed to assess absenteeism with a focus on the number of days absent due to ill health, number of days on sick leave and job loss (i.e., work disability or early retirement) [8]. Not all instruments are validated, and many lack information on reliability. Measuring presenteeism is even more complicated as many factors have an impact on the output, including job type, control over work, replacement by colleagues, size of company, profession and financial
Absenteeism in patients treated with biologics
Since the introduction of etanercept, many new biologic therapies have been approved to treat RA showing good results in controlling the disease and preventing radiographic progression in most patients. However, in most countries, biologic therapies can only be prescribed after the failure of two synthetic disease-modifying anti-rheumatic dugs (sDMARDs) [15] by which time many patients may have already lost their job [4]. Given the change in treatment strategies to early aggressive treatment
Presenteeism in patients treated with biologics
Presenteeism is defined as reduced productivity due to ill health while at work. Table 2 gives an overview of studies measuring presenteeism in patients treated with biologic therapy including four RCTs [19], [23], *[24], [25], four open-label extension studies of RCTs [29], [30], [31], [41] and six observational studies [35], [40], [42], [43], [44], [45]. Measures of presenteeism included the HLQ [46], the WLQ [47], the WPAI [48] and the Work Ability Index (WAI) [49]. Although all measures
Indirect costs due to RA
Compared with other diseases, costs associated with RA are high. In a study by Goetzel et al. [50] using the Medstat MarketScan Health and Productivity Management (HPM) database, the costs associated with the most prevalent and costly diseases were explored, including arthritis. Survey data were used to estimate annual indirect costs, and direct costs were extracted from the database. Productivity losses were calculated based on the percentage of eligible work time available per year for those
Indirect costs in patients with RA treated with biologics
Of the studies described in Table 1, Table 2, only a few calculated indirect costs due to absenteeism and/or presenteeism *[24], [28], [37], [39]. Using registry data (Stockholm anti-TNF follow-up registry (STURE)), Augustsson et al. [37] calculated costs due to absenteeism following patients with RA using anti-TNF therapy (infliximab (52.9%), etanercept (34.5%) and adalimumab (12.6%)) for a maximum of 5 years. Productivity costs were calculated by multiplying the area under the curve from
Conclusion
This paper reviews the impact of RA on work, with a focus on the effect of biologic treatment on absenteeism and presenteeism. In the majority of studies, absenteeism and presenteeism outcomes are included as secondary outcome measures, but for many patients with RA, remaining at work is an important outcome. There is some evidence that treatment with biologics and sDMARDs results in less presenteeism and absenteeism, but most studies only include patients with long-standing RA, and many
Conflicts of interest
No specific conflicts of interest to declare for this manuscript.
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