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P192. Productivity losses in inflammatory bowel disease: A systematic review

M. Van der Valk1, M.‑J. Mangen2, P. Siersema3, M. Van Oijen3, B. Oldenburg4

1University Medical Center Utrecht, Gastroenterology and Hepatology, Utrecht, Netherlands; 2University Medical Center Utrecht, Julius Centre for Health Sciences and Primary Care, Utrecht, Netherlands; 3University Medical Center Utrecht, Department of Gastroenterology and Hepatology, Utrecht, Netherlands; 4University Medical Centre Utrecht, Department of Gastroenterology, Utrecht, Netherlands

Background: The high costs associated with inflammatory bowel disease (IBD) are widely acknowledged but little is known of scale and determinants of costs. To gain better insight into productivity losses and associated costs in IBD, we critically appraised the available literature on this topic.

Methods: Relevant literature was retrieved from PubMed until August 2011 using (“inflammatory bowel disease” OR “Crohn's disease” OR “ulcerative colitis”) AND (“indirect costs” OR “productivity” OR “absenteeism” OR “presenteeism” OR “leisure”). Productivity losses included (1) absenteeism (days lost from work due to sick leave from work or work disability); (2) presenteeism (decreased productivity at work); or (3) loss of leisure (i.e. lost time spent on unpaid work activities such as household work, shopping and child care). Costs derived from each study were updated to the year 2010 using country specific consumer price index and converted to US dollars.

Results: A total of 14 articles were included in the evaluation. Eight studies focused on absenteeism due to work disability and percentages of work disability ranged between 5%-32% in CD and 5%-23% in UC. Annualized costs were $13,189 in CD and $6,821 in UC, which was 49% of total costs in CD and 32% of total costs in UC. Absenteeism due to sick leave was reported in 11 studies and occurred in 14%-50% of all CD patients with a median days lost of work between 10–30 days per year, as compared to 15%-29% in UC patients with a median lost days of work between 10–12 days per year. Associated costs varied between $1,136-$6,959 in CD and $909-$8,274 in UC, accounting for 15%-29% of the total costs in CD as compared to 18%-22% in UC. Four randomized clinical trials incorporated presenteeism and found a mean reduction of work productivity due to IBD ranging from 34% to 48%. Loss of leisure accounted for 37% of the total costs with a mean annualized costs of $2,976 in CD. We identified much heterogeneity regarding measurement of productivity losses, and the key components in the calculation of costs – the quantity of resources used and the unit costs – were in 8 of 14 studies not stated, rendering results incomparable and less transparent.

Conclusions: In both UC and CD, high productivity losses and associated costs are encountered, mainly due to absenteeism. We highly recommend to improve standardization in methodology and reporting, to order to improve comparability between studies.