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Rheumatoid arthritis and work: The impact of rheumatoid arthritis on absenteeism and presenteeism

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Abstract

For patients with rheumatoid arthritis (RA), being in paid work is very important, and it increases self-esteem and financial independence. Although the management of RA has changed in the last 15 years to early aggressive treatment and the introduction of biologic treatments, many patients still have to take sick leave or even stop working because of their RA (i.e., absenteeism). For those remaining in paid work, patients may experience problems due to RA resulting in productivity loss while at work (i.e., presenteeism). The costs attributed to absenteeism and presenteeism (i.e., indirect costs) have been estimated to be very high, and they even exceed direct costs. However, there is no consensus on how to calculate these costs. This manuscript examines the relationship between the use of biologic therapy and absenteeism, with a focus on sick leave, and on presenteeism, and it provides an overview of indirect costs of absenteeism and presenteeism in those treated with biologic therapies.

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.

References (56)

  • C.D. Hansen et al.

    Going ill to work–what personal circumstances, attitudes and work-related factors are associated with sickness presenteeism?

    Soc Sci Med

    (2008 Sep)
  • W.B. Brouwer et al.

    Productivity losses without absence: measurement validation and empirical evidence

    Health Policy

    (1999 Jul)
  • W. Zhang et al.

    An update on the measurement of productivity losses due to rheumatoid diseases

    Best Pract Res Clin Rheumatol

    (2012 Oct)
  • M.F. Drummond et al.

    Methods for economic evaluation of health care programmes

    (2005)
  • K. Tang et al.

    Measuring the impact of arthritis on worker productivity: perspectives, methodologic issues, and contextual factors

    J Rheumatol

    (2011 Aug)
  • L.M. Lamers et al.

    The relationship between productivity and health-related quality of life: an empirical exploration in persons with low back pain

    Qual Life Res

    (2005 Apr)
  • S.M. Verstappen et al.

    Overview of work disability in rheumatoid arthritis patients as observed in cross-sectional and longitudinal surveys

    Arthritis Rheum

    (2004 Jun 15)
  • W. Burton et al.

    Systematic review of studies of productivity loss due to rheumatoid arthritis

    Occup Med (Lond)

    (2006 Jan)
  • T. Sokka et al.

    Work disability remains a major problem in rheumatoid arthritis in the 2000s: data from 32 countries in the QUEST-RA study

    Arthritis Res Ther

    (2010)
  • M. Neovius et al.

    How large are the productivity losses in contemporary patients with RA, and how soon in relation to diagnosis do they develop?

    Ann Rheum Dis

    (2011 Jun)
  • S. Mattke et al.

    A review of methods to measure health-related productivity loss

    Am J Manag Care

    (2007 Apr)
  • I. Robertson et al.

    Poor health but not absent: prevalence, predictors, and outcomes of presenteeism

    J Occup Environ Med

    (2012 Nov)
  • M.V. Pauly et al.

    Valuing reductions in on-the-job illness: 'presenteeism‘ from managerial and economic perspectives

    Health Econ

    (2008 Apr)
  • R. Sogaard et al.

    The significance of presenteeism for the value of lost production: the case of rheumatoid arthritis

    Clin Outcomes Res

    (2010)
  • R. Escorpizo et al.

    Worker productivity outcome measures in arthritis

    J Rheumatol

    (2007 Jun)
  • K. Tang et al.

    Worker productivity outcome Measures: OMERACT filter evidence and agenda for future research

    J Rheumatol

    (2014 Jan)
  • P. Putrik et al.

    Inequities in access to biologic and synthetic DMARDs across 46 European countries

    Ann Rheum Dis

    (2014 Jan)
  • S.M. Verstappen et al.

    Working status among Dutch patients with rheumatoid arthritis: work disability and working conditions

    Rheumatol (Oxford)

    (2005 Feb)
  • M.M. ter Wee et al.

    The effect of biological agents on work participation in rheumatoid arthritis patients: a systematic review

    Ann Rheum Dis

    (2012 Feb)
  • S.M. Verstappen et al.

    Working status in patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis: results from the British Society for Rheumatology Biologics Register

    Rheumatol (Oxford)

    (2010 Aug)
  • R.F. van Vollenhoven et al.

    Improvement in work place and household productivity for patients with early rheumatoid arthritis treated with adalimumab plus methotrexate: work outcomes and their correlations with clinical and radiographic measures from a randomized controlled trial companion study

    Arthritis Care Res (Hoboken)

    (2010 Feb)
  • J.S. Smolen et al.

    Infliximab treatment maintains employability in patients with early rheumatoid arthritis

    Arthritis Rheum

    (2006 Mar)
  • J.C. Cole et al.

    Treatment impact on estimated medical expenditure and job loss likelihood in rheumatoid arthritis: re-examining quality of life outcomes from a randomized placebo-controlled clinical trial with abatacept

    Rheumatology (Oxford)

    (2008 Jul)
  • V. Bejarano et al.

    Effect of the early use of the anti-tumor necrosis factor adalimumab on the prevention of job loss in patients with early rheumatoid arthritis

    Arthritis Rheum

    (2008 Oct 15)
  • A. Kavanaugh et al.

    Effect of certolizumab pegol with methotrexate on home and work place productivity and social activities in patients with active rheumatoid arthritis

    Arthritis Rheum

    (2009 Nov 15)
  • A. Anis et al.

    The effect of etanercept on work productivity in patients with early active rheumatoid arthritis: results from the COMET study

    Rheumatol (Oxford)

    (2009 Oct)
  • J.M. Hazes et al.

    Physical function improvements and relief from fatigue and pain are associated with increased productivity at work and at home in rheumatoid arthritis patients treated with certolizumab pegol

    Rheumatol (Oxford)

    (2010 Oct)
  • W. Zhang et al.

    Does achieving clinical response prevent work stoppage or work absence among employed patients with early rheumatoid arthritis?

    Rheumatol (Oxford)

    (2012 Feb)
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