Background Biologics are expensive, but productivity losses are the greatest cost driver in working age patients with rheumatoid arthritis (RA). While many studies have estimated various aspects of the economic burden in RA, few studies have explored productivity losses in psoriatic arthritis (PsA), ankylosing spondylitis (AS), inflammatory bowel disease (IBD), or psoriasis (Pso) in relation to start of biologic treatment.
Objectives To estimate monthly days on sick leave and disability pension in relation to first ever initiation of biologic therapy in patients with RA, PsA, AS, IBD or Pso.
Methods Patients 18-64y at their first ever initiation of biologic therapy between 2006 through 2010, with ≥2 visits listing diagnosis of RA, PsA, AS, IBD or Pso, respectively, whereof ≥1 visit after Jan 1st, 2001, were identified from the Prescribed Drug Register and the Swedish National Patient Register. The Swedish Rheumatology Quality Register was also used for identifying patients with RA, PsA and AS. Complete data on sick leave and disability pension until Dec 31st, 2010, were retrieved from the Social Insurance Office. Patients were followed for a maximum of 2 years and were excluded from the monthly average calculations if they (in the current month) had emigrated, died, turned 65y, or if the calendar date was later than Dec 31st, 2010.
Results The number of patients identified was for RA 4394 (mean age 50y; 76% women); PsA 1658 (47y; 49%); AS 1198 (43y; 31%), IBD 1764 (41y; 52%), and Pso 359 (45y; 30%), with a mean follow-up time of 20 (median=24) months in PsA, AS, IBD and Pso, and 19 (24) months in patients with RA. The mean work loss days in RA, PsA, AS, and IBD followed a similar pattern, with increasing days from 12 months before start of biologic therapy, peaked the month after treatment start, and thereafter decreased (figure). Patients with PsA, AS and IBD reduced their work loss days to the same level 24 months after as compared to 12 months before treatment start, while patients with RA had an average of 1.2 days/month (95%CI 0.5-1.8) more at 24 months after as compared to 12 months before treatment initiation. Patients with Pso did not change their work loss days over follow-up but remained at 5-6 days/month.
Standardizing the PsA, AS, and IBD cohorts to the same age and sex distribution as the RA cohort resulted in a similar peak for all these diagnoses in the month after start of biologic therapy (14 days/month in RA, AS, and IBD, and 15 days/month in patients with PsA). The corresponding standardized work loss in patients with Pso was 7 days/month, and 5 days/month in general population comparators.
Conclusions Work loss days in relation to first ever initiation of biologic therapy in patients with RA, PsA, AS and IBD followed a similar pattern, and with a similar average level when adjusting for age and sex, while patients with Pso had half of the work loss observed in RA.
Eriksson JK, Johansson K, Askling J, et al. Costs for hospital care, drugs and lost work days in incident and prevalent rheumatoid arthritis: how large, and how are they distributed? Ann Rheum Dis 2013.
Disclosure of Interest None declared