Health-Related Quality of Life Impairment and Indirect Cost of Crohn's Disease: A Self-Report Study in Poland.

Przemysław Holko,Małgorzata Mossakowska,Paweł Kawalec,Andrzej Pilc

doi:10.1371/journal.pone.0168586

Abstract

Background and AimsEvidence on indirect cost of Crohn’s disease (CD) is available but typically provides information on the loss of productivity at paid work of patients. In the present study, the quality of life and indirect costs of CD patients were assessed (overall and by disease severity).MethodsA self-report questionnaire-based study among adult Polish patients with CD was performed. We collected data on patients’ characteristics, quality of life, loss of productivity, consumption of medical resources, and out-of-pocket expenses. The disease severity was determined using the patient’s version of the Harvey-Bradshaw index. Productivity costs were assessed from the social perspective, using a human capital approach. The cost of absenteeism, presenteeism and permanent work disability was valuated using the gross domestic product per worker. The patients’ productivity loss at unpaid work was measured by time inputs of others to assist patients. The productivity loss among informal caregivers and patients’ productivity loss at unpaid work were valuated with the average wage in Poland. The results were adjusted for confounders.ResultsThe responses from 200 patients (47% in remission) were analysed. The mean utility index was 0.839 (SD 0.171). The total indirect cost was estimated at €462.47 per patient per month (24.0%, absenteeism; 35.0%, work disability; 30.4%, presenteeism; 0.4%, productivity loss at unpaid work; and 10.4%, informal care). A significant correlation of the quality of life and productivity losses with disease severity was observed. Compared with active disease, the remission subgroup had a higher utility index by 16% (p<0.001) and lower indirect costs by 71% (p = 0.003) for absenteeism, 41% (p = 0.030) for presenteeism, 76% (p<0.001) for productivity loss at unpaid work, and 75% (p<0.001) for informal care.ConclusionsOur study revealed the social burden of CD and high dependency of indirect costs and quality of life on the severity of CD in Poland.

Highlights

Productivity costs usually include the loss of productivity at paid and unpaid work of patients and/or their caregivers, assessed from different economical perspectives such as those of the employer, society, or public finances
Our study revealed the social burden of Crohn’s disease (CD) and high dependency of indirect costs and quality of life on the severity of CD in Poland
The comparison of current disease activity and disease activity assessed by a clinician at the last consultation revealed a percentage agreement of 79.1% and Cohen’s κ of 0.497 (p

Summary

Introduction

Productivity costs usually include the loss of productivity at paid and unpaid work of patients and/or their caregivers, assessed from different economical perspectives such as those of the employer, society, or public finances. The high burden in workrelated outcomes among patients with IBD have been documented, only in a limited number of studies assessing productivity loss at paid work due to Crohn’s disease (CD) alone [7,8]. Evidence on indirect cost of Crohn’s disease (CD) is available but typically provides information on the loss of productivity at paid work of patients. The quality of life and indirect costs of CD patients were assessed (overall and by disease severity)

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Conclusion