Productivity loss outcomes and indirect costs among patients (Pts) with cholangiocarcinoma (CCA).

Abstract

392 Background: CCA pts, often diagnosed at older age with advanced disease, face poor prognoses and economic burden. Despite increasing CCA incidence in working age pts, little is known on financial impact on working pts. This study describes the impact of CCA on productivity loss and indirect costs due to workplace absence, short-term disability (STD), and long-term disability (LTD). Methods: Retrospective claims data from IBM MarketScan Commercial and Health and Productivity Management (HPM) databases between 7/1/2010 to 12/31/2019 were used. Eligible pts were ≥18 years, had ≥1 non-ruleout claim for CCA ( ICD-9/ -10: intrahepatic [iCCA]: 155.1/C221; extrahepatic [eCCA]: 156.1, 156.9/C240, C249) in the index period (1/1/2011 – 12/31/2019), and had ≥6 months of continuous medical and pharmacy benefit enrollment before and ≥1 month of follow-up and full-time employee eligibility after index date. Productivity loss as absenteeism, STD, and LTD among iCCA and eCCA was reported per pt per month (PPPM) for a work month of 21 days. Absenteeism was defined as absence days for illness; STD and LTD were defined as days on disability leave. Indirect cost was estimated using wage equivalent to median hourly wage rate and salary replacement rate of 70% from US Bureau of Labor and Statistics. Results: A total of 1065 CCA pts (iCCA, n=624 [58.6%]; eCCA, n=380 [35.7%]) were identified. The number of productivity benefit–eligible pts for analysis in absenteeism, STD, and LTD were 107, 617, and 549, respectively. Across cohorts, mean age ranged from 51.9 to 53.9 years; >60% were men. Mean (SD) follow-up time (days) was 725.0 (730.4) for absenteeism, 639.7 (587.0) for STD, and 614.4 (583.2) for LTD. The most notable comorbidities across cohorts were moderate/severe liver disease (58–63%) and pain (67–71%). Among pts with productivity claims, more CCA-related absences and higher related indirect costs were observed in iCCA than eCCA pts. The trend in all-cause disability outcomes of STD, LTD, and related costs was less clear between iCCA and eCCA pts; however, medical costs were higher in iCCA pts. Conclusions: CCA pts had high productivity loss and indirect costs, which is pt costs due to days missed from work in addition to medical costs; iCCA pts incurred substantially more absences, related indirect costs, and medical costs than eCCA pts.[Table: see text]