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Work status and productivity costs due to ankylosing spondylitis: comparison of three European countries
  1. A Boonen1,
  2. D van der Heijde2,
  3. R Landewé1,
  4. A Spoorenberg1,
  5. H Schouten2,
  6. M Rutten-Van Mölken3,
  7. F Guillemin4,
  8. M Dougados5,
  9. H Mielants6,
  10. K de Vlam6,
  11. H van der Tempel7,
  12. Sj van der Linden1
  1. 1Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, The Netherlands
  2. 2Department of Methodology and Statistics, University of Maastricht, The Netherlands
  3. 3Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
  4. 4EA 1124-Department of Clinical Epidemiology and Evaluation, University Hospital Nancy, France
  5. 5Department of Rheumatology, Université Réné Descartes, Hopital Cochin, Paris, France
  6. 6Department of Rheumatology, University Hospital Ghent, Belgium
  7. 7Maasland Ziekenhuis Sittard, The Netherlands
  1. Correspondence to:
    Dr A Boonen, Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, PO box 5800, 6202 AZ Maastricht, The Netherlands;


Objective: To compare work disability, sick leave, and productivity costs due to ankylosing spondylitis (AS) of three European countries.

Methods: 216 patients with AS from the Netherlands, France, and Belgium participated in a two year observational study. Employment and work disability rates at baseline were adjusted for age and sex. Productivity costs were calculated by both the friction cost method and the human capital approach. The adjusted contributions of country to employment, work disability, and having an episode of sick leave were assessed by logistic regression and the contribution of the country to days of sick leave and costs by Cox proportional hazard analysis.

Results: 209 patients completed the two years' follow up with sufficient data for cost analysis. Adjusted employment was 55% in the Netherlands as compared with 72% in both other countries and only in the Netherlands was it lower than expected in the general population. Adjusted work disability was 41%, 23%, and 9% in the Netherlands, France, and Belgium and in all countries was higher than expected in the general population. In those with a paid job, the mean number of days of sick leave per patient per year because of AS was 19 (range 0–130), six (range 0–77), and nine (range 0–60 ) in the Netherlands, France, and Belgium respectively. Applying the friction cost method to those with a paid job resulted in mean costs per patient per year of 1257 euros (range 0–7356), 428 euros (range 0–5979), and 476 euros (range 0–2354) in the Netherlands, France, and Belgium. Applying the human capital approach to the whole group resulted in mean costs per patient per year of 8862 euros (range 0–46 818), 3188 euros (range 0–43 550), and 3609 euros (range 0–34 320) in the three countries, respectively. After adjusting for sociodemographic and disease characteristics, living in the Netherlands, as compared with both other countries, was associated with a higher chance of being work disabled (odds ratio (OR)=3.82; 95% confidence interval (CI) 1.33 to 11.01), but not with the risk of having an episode of sick leave. Similarly, living in the Netherlands contributed independently to the number of days sick leave (OR=0.65; 95% CI 0.43 to 0.97), a higher amount of friction costs (OR=0.63; 95% CI 0.42 to 0.96), and a higher amount of human capital costs (OR=0.46; 95% CI 0.32 to 0.68).

Conclusion: There are remarkable differences in work status and productivity costs between the three European countries. This has implications for the generalisability of health economic studies.

  • ankylosing spondylitis
  • employment
  • costs
  • economic analysis
  • ANOVA, analysis of variance
  • AS, ankylosing spondylitis
  • B, Belgium
  • BASDAI, Bath Ankylosing Spondylitis Disease Activity Index
  • BASFI, Bath Ankylosing Spondylitis Functional Index
  • CI, confidence interval
  • EQ-5D, EuroQol 5 dimensions instrument
  • F, France
  • FC
  • friction costs
  • HC, human capital
  • IBD, inflammatory bowel disease
  • NL, the Netherlands
  • OR, odds ratio
  • QoL, quality of life
  • RA, rheumatoid arthritis
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