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Lost Productivity Costs High for SLE, Sjögren's, Systemic Sclerosis
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For patients with systemic lupus erythematosus, systemic sclerosis and Sjögren’s syndrome, the productivity costs due to loss of paid and unpaid work were substantial, particularly due to presenteeism and unpaid work impairments, according to findings published in Arthritis Care and Research.
“Systemic lupus erythematosus (SLE), systemic sclerosis and Sjögren’s syndrome strike mainly females during their peak childrearing and career years, yet little is known about the additional lost productivity costs associated with these diseases,” Natalie McCormick, PhD, of the University of British Columbia and Arthritis Research Canada, told Healio Rheumatology. “Two unique aspects of this study are that we included the costs of diminished productivity from paid and unpaid work, and we compared the costs of these patients with a sample of the general population, to determine the additional — or excess — costs.”
To determine excess productivity losses among patients with SLE, systemic sclerosis and Sjogren’s syndrome, McCormick and colleagues drew from Population Data BC, which uses population-based administrative information files to capture all publicly-funded health care services in British Columbia, Canada. After identifying a random sample of 2,400 people, including patients with SLE, systemic sclerosis and Sjogren’s syndrome, as well as those without systemic autoimmune rheumatic diseases, the researchers sent out surveys regarding the loss of paid and unpaid work.
The surveys also asked about presenteeism — or working at reduced levels and efficiency. The study included 167 patients with SLE, 90 patients with Sjögren’s syndrome, 42 with systemic sclerosis and 375 healthy controls. The researchers used their answers, twopart models and work disability rates to estimate productivity losses and costs related to each diagnosis compared to the healthy controls.
According to the researchers, the predicted weekly excess hours of paid and unpaid work loss were 3.5 for SLE, 3.2 for systemic sclerosis and 3.4 for Sjögren’s syndrome. In Canadian dollars, this comverts to $86, $69 and $84 in excess costs per week, or $4,494, $3,582, and $4,357 per person annually, for patients with SLE, systemic sclerosis and Sjögren’s syndrome, respectively. Lost paid work was caused mainly by presenteeism, which represented 69% of costs for patients with SLE, 67% for those with systemic sclerosis, 64% for patients with Sjögren’s syndrome and 53% for the healthy controls.
However, the researchers added that many working-age patients were not employed at all due to health, and that a majority of total productivity costs were due to unpaid work losses. These losses made up for 73% of costs for patients with SLE, 74% for those with systemic sclerosis, 60% for patients with Sjögren’s syndrome and 47% for the healthy controls. The adjusted weekly excess costs from these unpaid losses were $127 for patients with SLE, $100 for those with systemic sclerosis and $82 for patients with Sjögren’s syndrome.
“When assessing and monitoring patients’ disease status and well-being, health care providers should consider all forms of paid and unpaid productivity loss, and changes in patients’ productivity levels and employment status,” McCormick said. “Though many patients are unable to work or have retired, others choose, or feel forced, to keep working, and do complete their paid work tasks, but with less time or capacity for household tasks and other forms of unpaid work.”
In addition, the excess productivity costs of these diseases were high, yet largely hidden, according to McCormick.
“Patients were two times more likely to be work-disabled — not employed, due to health — than nonpatients,” she said. “Further, although employed patients weren’t absent from paid work more than nonpatients, they often couldn’t perform this work as efficiently, nor their essential tasks at home. These excess costs impact patients, families, employers and society.” – by Jason Laday
Disclosure: McCormick reports funding provided by the Canadian Institutes of Health Research and the BC Lupus Society, as well as administrative and research support from Arthritis Research Canada. Please see the study for all other authors’ relevant financial disclosures.
Perspective
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Daniel J. Wallace, MD, FACP, MACR
In the United States, about one-third of lupus patients are disabled at 5 years and another third have had to change their job or job description. Despite some of the limitations identified below, the study highlights the “hidden” societal costs of these diseases, and thus represents an important contribution to efforts to develop value-based payment models that might reward physicians for the proper management of patients with chronic diseases.
The weaknesses of this study include that no charts were reviewed and that patients were identified from physician coding at the visit, who was not necessarily a rheumatologist. Many patients diagnosed with SLE or Sjögren’s have both; sometimes the distinction is artificial. The sample sizes were small and might not be reliable. Also, the reader is not told anything about the demographics of the autoimmune patients (for example, sex, age, ethnicity) or what medications they were taking.
In addition, the study is not representative of the overall autoimmune population with these 3 disorders because many are never able to work at all. The health care system and disability regulations are much different in Canada than in the United States. In any case, this is an important study which points out that individuals with SLE, systemic sclerosis and Sjögren’s have more absenteeism and productivity issues than those without.
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