Relationship Between Work Productivity and Clinical Characteristics in Rheumatoid Arthritis

OBJECTIVE

This study assesses the relationship between the ability to perform productive activities and the clinical characteristics of RA, such as disease activity, quality of life, functional capacity, workload, pharmacotherapy, and comorbidities.

MATERIALS AND METHODS

A cross-sectional, observational and descriptive study was conducted. Patients aged 18-75years with a diagnosis of RA according to ACR/EULAR 2010 criteria who attended regularly to the Rheumatology service in the period between January and March 2017 were included. The questionnaires, WPAI-AR, HAQ-DI and RAQoL, were applied. RA disease activity was measured by DAS28-PCR. Correlations were made between the clinical data obtained and work productivity and activity impairment measured by WPAI-AR.

RESULTS

Two hundred four patients with a diagnosis of RA were included, of whom 92.6% were women. Mean age was 54.46±9.3years. Regarding the percentage of impairment of daily life activities, we found a significant difference between employed and unemployed patients (P≤.002). A positive correlation was found between RA activity measured by DAS28-PCR, quality of life, and functional ability with the percentages of absenteeism, presenteeism, overall productivity loss, and impairment of daily life activities.

CONCLUSION

A correlation between RA disease activity, functional capacity, quality of life, and working impairment was found. The strongest association was established with the degree of functional capacity.

[Prevalence and characterization of overactive bladder detected in a population in Madrid with self-administered OAB-V3 questionnaire in Primary Care]

Objetivo

Determinar la prevalencia de síntomas sugestivos de vejiga hiperactiva (VH) en una población española y evaluar su impacto en el bienestar y la productividad laboral de esta población.

Diseño

Estudio transversal.

Emplazamiento

Atención primaria, Madrid, España.

Participantes

Varones y mujeres > 30 años.

Intervenciones

Clasificación con el instrumento abreviado Overactive Bladder Awareness Tool (OAB-V3). Sujetos con puntuación ≥ 3 y una población control similar con puntuación < 3 fueron investigados clínicamente.

Mediciones principales

Anamnesis, exploración física, análisis de orina, ecografía, escala de bienestar general y cuestionarios PPBC, OAB-q y WPAI-SHP.

Resultados

Se cribaron 923 sujetos, 209 (22,6%) de los cuales —35% hombres y 65% mujeres— presentaron probable VH. La distribución por edad aumentó del 11,1% en la cuarta década al 44,4% en la novena década. El coeficiente kappa entre probable VH y diagnóstico definitivo fue de 0,83. El área bajo la curva ROC para el diagnóstico según el cuestionario OAB-V3 y la constatación de molestias percibidas y estrategias de afrontamiento fue del 92%. Los sujetos clasificados por OAB-V3 ≥ 3 tuvieron peor bienestar, mayor puntuación PPBC y peores parámetros en las puntuaciones OAB-q total y transformadas para cada subescala OAB-q (p < 0,0001). Su productividad laboral no se vio afectada (p = 0,14), pero sí la capacidad de realizar actividades cotidianas (p < 0,0001).

Conclusiones

OAB-V3 es un cuestionario simple para el cribado de VH con buena exactitud de predicción en atención primaria y que conlleva implicaciones importantes en la calidad de vida relacionada con la salud.

Cost of myopic patients with and without myopic choroidal neovascularisation

OBJECTIVE

To study the costs associated with high myopia (HM) with choroidal neovascularisation (mCNV) or without mCNV.

METHODS

Observational, retrospective, cross-sectional, and multicentre study (HM and mCNV) conducted on adult patients. Annualised medical direct cost (MDC) from the perspective of the National Health System, the non-medical direct cost (nMDC) from the patient perspective, and productivity losses were calculated.

RESULTS

A total of 137 mCNV and 48 HM patients were included (mean age [SD]: 55.1 [2.8] vs. 54.7 [13.8]; P=.2), with 80% women in both groups. The observation time (months) ranged from 17.9 (9.6) right eye (RE) and 20.0 (9.7), left eye (LE) in mCNV and 47.1 (21.5) RE/45.5 (20.7) LE in MM. A higher percentage of emergency room visits was observed in mCNV vs. HM patients (41.7 vs. 25%; P=.06) and retinal specialists (91.2 vs. 77.1%; P=.01). The MDC was higher in mCNV: € 1,985 (95% CI: 1772-2198) vs. € 356 (251-480) HM, P<.001. The nMDC was also higher in mCNV: € 256 (11-524) vs. €19 (11-26) HM, P>.4. The number of affected eyes, the follow-up time, and the mCNV were factors associated with direct costs. The impact on work productivity was higher in mCNV (quite/very concerned): 27.7 vs. 10.4% HM. The mCNV showed a significant association with activity impairment (OR: 3.47, 95% CI: 10.101-1.195).

CONCLUSIONS

mCNV involves higher medical costs than HM. In addition, mCNV patients have a greater need of care and assistive devices, and greater impact of the disease in their work productivity.

Productivity loss due to premature mortality caused by blood cancer: a study based on patients undergoing stem cell transplantation

INTRODUCTION

Stem cell transplantation has been used for many years to treat haematological malignancies that could not be cured by other treatments. Despite this medical breakthrough, mortality rates remain high. Our purpose was to evaluate labour productivity losses associated with premature mortality due to blood cancer in recipients of stem cell transplantations.

METHODS

We collected primary data from the clinical histories of blood cancer patients who had undergone stem cell transplantation between 2006 and 2011 in two Spanish hospitals. We carried out a descriptive analysis and calculated the years of potential life lost and years of potential productive life lost. Labour productivity losses due to premature mortality were estimated using the Human Capital method. An alternative approach, the Friction Cost method, was used as part of the sensitivity analysis.

RESULTS

Our findings suggest that, in a population of 179 transplanted and deceased patients, males and people who die between the ages of 30 and 49 years generate higher labour productivity losses. The estimated loss amounts to over €31.4 million using the Human Capital method (€480,152 using the Friction Cost method), which means an average of €185,855 per death. The highest labour productivity losses are produced by leukaemia. However, lymphoma generates the highest loss per death.

CONCLUSIONS

Further efforts are needed to reduce premature mortality in blood cancer patients undergoing transplantations and reduce economic losses.

Workplace accidents, absenteeism and productivity in patients with sleep apnea

INTRODUCTION

Obstructive sleep apnea-hypopnea syndrome (OSAHS) has health-related outcomes, but the impact of OSAHS on occupational health has been scarcely studied. The aim of this study was to evaluate the effect of OSAHS on workplace accidents, absenteeism and productivity.

METHOD

One hundred eighty-two OSAHS patients and 71 healthy subjects completed the Epworth Sleepiness Scale, the Pittsburgh Sleep Quality Index and the Spanish IMPALA (Impact of Disease on Work Productivity) index and answered various questions on workplace accidents and sick leave. Participants were classified to an OSAHS group or a non-OSAHS group according to polysomnography results.

RESULTS

Patients with OSAHS had more sick leave lasting longer than 30days (16.6% vs. 7%, P=.049) and lower productivity (63.80% vs. 83.20%, P=.000) than subjects without OSAHS, although the rate of workplace accidents was similar in both groups (27.4% vs 25.4%; P>.050). None of the OSAHS-related variables was associated with workplace accidents. A diagnosis of OSAHS was related with absenteeism. Psychological distress and OSAHS were related with productivity.

CONCLUSIONS

OSAHS causes limitations in the working lives of patients and leads to a higher incidence of sick leave and lower productivity. A diagnosis of OSAHS was the variable with most influence on the working lives of patients.