Clinical Rheumatology

, Volume 30, Supplement 1, pp 25–32 | Cite as

The economic burden of rheumatoid arthritis: beyond health care costs

Article

Abstract

Rheumatoid arthritis (RA) not only causes significant morbidity, but also leads to substantial losses in terms of productivity that have a negative impact on the individual and the society. In countries, such as Canada, the US, and the UK, it is known that the costs to the economy in terms of sick leave and work-related disability run into billions of dollars. However, putting an accurate figure on these losses is not entirely straightforward. Most health-related studies use the “human capital” approach, which treats human beings as assets. A figure for lost productivity is calculated by multiplying hours lost by the hourly wage rate. It is a method that is not without its critics because of its emphasis on earning power, which discriminates against non-earners. Another method is the “friction-cost” approach, whereby absenteeism is only recorded if the missed work requires extra hours undertaken, either by the employee himself, or by the others. A third method is the “willingness-to-pay” approach which values life according to an individual's preference to avoid illness with an imputed monetary valuation on the various health outcomes being considered. A number of studies have shown that biologic RA treatments provide productivity benefits in terms of maintaining employment, as well as reducing absenteeism and presenteeism. Going forward, an approach recently adopted by the present authors with encouraging preliminary results, the Valuation of Lost Productivity, takes into account a wide range of factors to provide a measure of productivity that is as accurate as possible.

Keywords

Absenteeism Arthritis Presenteeism Productivity Rheumatoid arthritis 

References

  1. 1.
    Kvien TK (2004) Epidemiology and burden of illness of rheumatoid arthritis. Pharmacoeconomics 22:1–12PubMedCrossRefGoogle Scholar
  2. 2.
    World Health Organization (2009) Chronic rheumatic conditions. http://www.who.int/chp/topics/rheumatic/en/. Accessed July 2009
  3. 3.
    Lundkvist J, Kastang F, Kobelt G (2008) The burden of rheumatoid arthritis and access to treatment: health burden and costs. Eur J Health Econ 8:S49–S60PubMedCrossRefGoogle Scholar
  4. 4.
    Lee P (1994) The economic impact of musculoskeletal disorders. Qual Life Res 3:S85–S91PubMedCrossRefGoogle Scholar
  5. 5.
    Hunsche E, Chancellor JV, Bruce N (2001) The burden of arthritis and nonsteroidal anti-inflammatory treatment. A European literature review. Pharmacoeconomics 19:1–15PubMedCrossRefGoogle Scholar
  6. 6.
    Health Canada (2003) Arthritis in Canada: An Ongoing Challenge. Cat. # H39-4/14-2003EGoogle Scholar
  7. 7.
    CDC (2007) National and state medical expenditures and lost earnings attributable to arthritis and other rheumatic conditions – United States, 2003. MMWR 56:4–7Google Scholar
  8. 8.
    National Audit Office (2009) Services for people with rheumatoid arthritis. Report by the comptroller and auditor general, HC 823 session 2008–2009. National Audit Office, 15 July 2009Google Scholar
  9. 9.
    Johannesson M (1996) The willingness to pay for health changes, the human-capital approach and the external costs. Health Policy 36:231–244PubMedCrossRefGoogle Scholar
  10. 10.
    Berger ML, Murray JF, Xu J, Pauly M (2001) Alternative valuations of work loss and productivity. J Occup Environ Med 43:18–24PubMedCrossRefGoogle Scholar
  11. 11.
    Pauly MV, Nicholson S, Xu J, Polsky D, Danzon PM (2002) A general model of the impact of absenteeism on employers and employees. Health Econ 11:221–231PubMedCrossRefGoogle Scholar
  12. 12.
    Nicholson S, Pauly MV, Polsky D, Sharda C, Szrek H, Berger ML (2006) Measuring the effects of work loss on productivity with team production. Health Econ 15:111–123PubMedCrossRefGoogle Scholar
  13. 13.
    Pauly MV, Nicholson S, Polsky D, Berger ML, Sharda C (2008) Valuing reductions in on-the-job illness: ‘presenteeism’ from managerial and economic perspectives. Health Econ 17:469–485PubMedCrossRefGoogle Scholar
  14. 14.
    Koopmanschap MA, Rutten FF, van Ineveld BM, van Roijen L (1995) The friction cost method for measuring indirect costs of disease. J Health Econ 14:171–189PubMedCrossRefGoogle Scholar
  15. 15.
    Jacob-Tacken KH, Koopmanschap MA, Meerding WJ, Severens JL (2005) Correcting for compensating mechanisms related to productivity costs in economic evaluations of health care programmes. Health Econ 14:435–443PubMedCrossRefGoogle Scholar
  16. 16.
    Olsen JA, Smith RD (2001) Theory versus practice: a review of ‘willingness-to-pay’ in health and health care. Health Econ 10:39–52PubMedCrossRefGoogle Scholar
  17. 17.
    Zhang W, Bansbank N, Anis AH. Measuring and valuing productivity loss due to poor health: a review. Soc Sci Med (in press)Google Scholar
  18. 18.
    Clarke AE, Zowall H, Levinton C et al (1997) Direct and indirect medical costs incurred by Canadian patients with rheumatoid arthritis: a 12 year study. J Rheumatol 24:1051–1060PubMedGoogle Scholar
  19. 19.
    Merkesdal S, Ruof J, Schoffski O, Bernitt K, Zeidler H, Mau W (2001) Indirect medical costs in early rheumatoid arthritis: composition of and changes in indirect costs within the first three years of disease. Arthritis Rheum 44:528–534PubMedCrossRefGoogle Scholar
  20. 20.
    Yelin E (1996) The costs of rheumatoid arthritis: absolute, incremental, and marginal estimates. J Rheumatol Suppl 44:47–51PubMedGoogle Scholar
  21. 21.
    Yelin E, Cisternas M, Pasta D, Trupin L (2003) Direct and indirect costs of musculoskeletal conditions in 1997: Total and incremental estimates. Centers for Disease Control and Prevention, AtlantaGoogle Scholar
  22. 22.
    Lerner D, Reed JI, Massarotti E, Wester LM, Burke TA (2002) The Work Limitations Questionnaire’s validity and reliability among patients with osteoarthritis. J Clin Epidemiol 55:197–208PubMedCrossRefGoogle Scholar
  23. 23.
    Maetzel A, Li LC, Pencharz J, Tomlinson G, Bombardier C, Community Hypertension and Arthritis Project Study Team (2004) The economic burden associated with osteoarthritis, rheumatoid arthritis, and hypertension: a comparative study. Ann Rheum Dis 63:395–401PubMedCrossRefGoogle Scholar
  24. 24.
    Stewart WF, Ricci JA, Chee E, Morganstein D, Lipton R (2003) Lost productive time and cost due to common pain conditions in the US workforce. JAMA 290:2443–2454PubMedCrossRefGoogle Scholar
  25. 25.
    Li X, Gignac MA, Anis AH (2006) The indirect costs of arthritis resulting from unemployment, reduced performance, and occupational changes while at work. Med Care 44:304–310PubMedCrossRefGoogle Scholar
  26. 26.
    Zhang W, Koehoorn M, Anis AH (2010) Work productivity among employed Canadians with arthritis. J Occup Environ Med 52:872–877PubMedCrossRefGoogle Scholar
  27. 27.
    Gignac MA, Badley EM, Lacaille D, Cott CC, Adam P, Anis AH (2004) Managing arthritis and employment: making arthritis-related work changes as a means of adaptation. Arthritis Rheum 51:909–916PubMedCrossRefGoogle Scholar
  28. 28.
    Gabriel SE, Crowson CS, Campion ME, O’Fallon WM (1997) Indirect and nonmedical costs among people with rheumatoid arthritis and osteoarthritis compared with nonarthritic controls. J Rheumatol 24:43–48PubMedGoogle Scholar
  29. 29.
    Yelin E, Henke C, Epstein W (1987) The work dynamics of the person with rheumatoid arthritis. Arthritis Rheum 30:507–512PubMedCrossRefGoogle Scholar
  30. 30.
    Yelin E, Sonneborn D, Trupin L (2000) The prevalence and impact of accommodations on the employment of persons 51–61 years of age with musculoskeletal conditions. Arthritis Care Res 13:168–176PubMedCrossRefGoogle Scholar
  31. 31.
    Reisine S, Fifield J, Walsh SJ, Feinn R (2001) Factors associated with continued employment among patients with rheumatoid arthritis: a survival model. J Rheumatol 28:2400–2408PubMedGoogle Scholar
  32. 32.
    Yelin E, Trupin L, Katz P, Lubeck D, Rush S, Wanke L (2003) Association between etanercept use and employment outcomes among patients with rheumatoid arthritis. Arthritis Rheum 48:3046–3054PubMedCrossRefGoogle Scholar
  33. 33.
    Bejarano V, Quinn MA, Conaghan PG et al (2007) Improved work stability and reduced job loss with adalimumab plus methotrexate in early rheumatoid arthritis: results of the Prevention Of Work Disability (PROWD) Study. Ann Rheum Dis 66(Suppl II):176Google Scholar
  34. 34.
    Smolen JS, Han C, van der Heijde D et al (2006) Infliximab treatment maintains employability in patients with early rheumatoid arthritis. Arthritis Rheum 54:716–722PubMedCrossRefGoogle Scholar
  35. 35.
    Augustsson J, Neovius M, Cullinane-Carli C, Eksborg S, van Vollenhoven RF (2010) Rheumatoid arthritis (RA) patients treated with TNF-antagonists increase their participation in the work-force—potential for significant long-term indirect cost gains. Data from a population-based registry. Ann Rheum Dis 69:126–131PubMedCrossRefGoogle Scholar
  36. 36.
    van den Hout WB, Goekoop-Ruiterman YP, Allaart CF et al (2009) Cost-utility analysis of treatment strategies in patients with recent-onset rheumatoid arthritis. Arthritis Rheum 61:291–299PubMedCrossRefGoogle Scholar
  37. 37.
    Anis A, Zhang W, Emery P et al (2009) The effect of etanercept on work productivity in patients with early active rheumatoid arthritis: results from the COMET study. Rheumatology 8:1283–1289CrossRefGoogle Scholar
  38. 38.
    Zhang W, Bansbank N, Guh D et al (2008) Short-term influence of adalimumab on work productivity outcomes in patients with rheumatoid arthritis. J Rheumatol 35:1729–1736PubMedGoogle Scholar
  39. 39.
    Loeppke R, Hymel PA, Lofland JH et al (2003) Health-related workplace productivity measurement: general and migraine-specific recommendations from the ACOEM Expert Panel. J Occup Environ Med 45:349–359PubMedCrossRefGoogle Scholar
  40. 40.
    Prasad M, Wahlqvist P, Shikiar R, Shih YC (2004) A review of self-report instruments measuring health-related work productivity: a patient-reported outcomes perspective. Pharmacoeconomics 22:225–244PubMedCrossRefGoogle Scholar
  41. 41.
    Lofland JH, Pizzi L, Frick KD (2004) A review of health-related workplace productivity loss instruments. Pharmacoeconomics 22:165–184PubMedCrossRefGoogle Scholar
  42. 42.
    Mattke S, Balakrishnan A, Bergamo G, Newberry SJ (2007) A review of methods to measure health-related productivity loss. Am J Manag Care 13:211–217PubMedGoogle Scholar
  43. 43.
    Escorpizo R, Bombardier C, Boonen A et al (2007) Worker productivity outcome measures in arthritis. J Rheumatol 34:1372–1380PubMedGoogle Scholar
  44. 44.
    Zhang W, Gignac MAM, Beaton D, Tang K, Anis AH, On behalf of the Canadian Arthritis Network Work Productivity Group (2010) Productivity loss due to presenteeism among patients with arthritis: estimates from 4 instruments. J Rheumatol 37:1805–1814PubMedCrossRefGoogle Scholar
  45. 45.
    Zhang W, Bansback N, Kiely P, Williams R, Walsh D, Young A, Anis AH (2010) Measuring work time loss among patients with rheumatoid arthritis: validating the valuation of lost productivity (VOLP) questionnaire. Ann Rheum Dis 69(Suppl3):467Google Scholar
  46. 46.
    Kennedy I (2009) Appraising the value of innovation and other benefits—a short study for NICE. NICE, LondonGoogle Scholar

Copyright information

© Clinical Rheumatology 2011

Authors and Affiliations

  1. 1.Centre for Health Evaluation and Outcome SciencesSt. Paul’s Hospital, Providence Health CareVancouverCanada
  2. 2.School of Population and Public HealthThe University of British ColumbiaVancouverCanada

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