Short-term Disability Claims Research Articles

EPH181 Real World Retrospective Analysis of Short-Term Disability Claims for the Genitourinary System in the United States

EPH181 Real World Retrospective Analysis of Short-Term Disability Claims for the Genitourinary System in the United States

RWD189 Exploration of Reason Codes in Real World Cardiovascular System Short-Term Disability Claims in the United States

RWD189 Exploration of Reason Codes in Real World Cardiovascular System Short-Term Disability Claims in the United States

The Omicron wave in Mexico: vaccine protection against progression to severe Covid-19 in SARS-CoV-2-infected workers

Objective. To assess the effectiveness of seven Covid-19 vaccines in preventing disease progression (DP) using data from national private sector workers during the Omicron wave in Mexico from January 2 to March 5, 2022. Materials and methods. This study employed an administrative retrospective cohort design, analyzing DP (hospitalization or death due to respiratory disease) among workers who filed a respiratory short-term disability claim and tested positive for SARS-CoV-2. Risk ratios (RRadj) were estimated using Poisson regression models adjusted for various factors. Results. Vaccinated individuals had a lower risk of hospitalization and death compared with unvaccinated individuals. The overall RRadj for hospitalization and death were 0.36 (95%CI 0.32, 0.41) and 0.24 (0.17, 0.33), respectively. When evaluating vaccines individually, the RRadj for hospitalization were as follows Pfizer BioNTech 0.27 (95%CI 0.22, 0.33), Moderna 0.29 (95%CI 0.15, 0.57), Sinovac 0.32 (95%CI 0.25, 0.41), AstraZeneca 0.39 (95%CI 0.34, 0.46), Sputnik 0.39 (95%CI 0.28, 0.53), CanSino 0.41 (95%CI 0.24, 0.7), and Janssen 0.53 (95%CI 0.39, 0.72). The RRadj for death were as follows: Pfizer BioNTech 0.12 (95%CI 0.07, 0.19), Sputnik 0.15 (95%CI 0.06, 0.38), Sinovac 0.29 (95%CI 0.16, 0.53), AstraZeneca 0.30 (95%CI 0.20, 0.44), CanSino 0.38 (95%CI 0.1, 1.4), and Janssen 0.50 (95%CI 0.26, 0.97). Conclusion. Covid-19 vaccines significantly reduced the risk of severe disease during the Omicron wave in Mexico.

SARS-CoV-2 seroprevalence and respiratory disease disability claims in Mexico City Metropolitan Area

Objective. To characterize the impact of SARS-CoV-2 infection in workers from an essential large-scale company in the Greater Mexico City Metropolitan Area using point prevalence of acute infection, point prevalence of past infection through serum antibodies and respiratory disease short-term disability claims (RD-STDC). Materials and methods. Four randomized surveys, three during 2020 before and one after (December 2021) vaccines’ availability. Outcomes: point prevalence of acute infection through saliva PCR (polymerase chain reaction) testing, point prevalence of past infection through serum antibodies against Covid-19, RD-STDC and prevalence of symptoms during the previous six months. Results. Prevalence of SARS-CoV-2 cases was 1.29-4.88%, on average, a quarter of participants pre-vaccination were seropositive; over half of participants with a RD-STDC had antibodies. The odds of having antibodies were 6-7 times more among workers with an RD-STDC. Conclusions. High antibody levels against Covid-19 in this study population reflects that coverage is high among workers in this industry. STDCs are a useful tool to track workplace epidemics.

Work absenteeism and disability days after diagnosis among patients with AML and caregivers.

e19002 Background: Treatment for acute myeloid leukemia (AML) includes intensive chemotherapy and/or hematopoietic stem cell transplant, and patients usually require extended hospital stays and absence from work. Caregivers may also take workplace absence to provide care during and after treatment. As data on the indirect burden of AML are underreported, we aimed to understand the impact of work absenteeism (ABS) and disability days among patients with AML and caregivers. Methods: This non-interventional, retrospective analysis of healthcare claims data was conducted using MarketScan Databases containing ABS data. Two cohorts were analyzed: patients newly diagnosed with AML between January 1, 2009 and December 1, 2019 (index period), and caregivers with an adult family member newly diagnosed with AML during the index period. All participants were full-time employees, aged 18–64 years, and had ≥12 months of continuous enrollment prior to index date and ≥30 days of continuous enrollment after index date. The index date was the date of first AML diagnosis for patients, or the date of the linked family member’s first AML diagnosis for caregivers. Participants were followed for ≥30 days up to 3 years, until the end of continuous enrollment, end of database eligibility, or end of the study period. Participants who were pregnant or in families with > 1 member with AML were excluded. Days of work loss and associated wage loss were calculated for each work loss type: ABS, short-term disability (STD), and long-term disability (LTD). Results: This analysis included 1,037 patients with AML and 781 caregivers. From baseline to follow-up (FU) period, the proportion of patients reporting ABS numerically decreased from 72.8% to 62.7% (p = 0.054), and changes in ABS days per patient per month (PPPM) (2.21– 2.10, p = 0.735) or ABS-related wage loss PPPM ($562–$511, p = 0.516) were not statistically significant. However, the proportion of patients reporting STD and LTD significantly increased (24.6%–50.0%, p < 0.001, and 4.0%–20.0%, p < 0.001, respectively). The number of days PPPM lost due to STD and LTD significantly increased (0.85–4.94, p < 0.001, and 0.24–1.40, p < 0.001), as did STD- and LTD-related wage loss PPPM ($203–$1194, p < 0.001, and $57–$330, p < 0.001). Among caregivers, the proportion reporting ABS and ABS days PPPM were similar between baseline and FU periods (83.2%–83.9%, p = 0.871, and 2.41–2.64, p = 0.315). The proportion of caregivers with STD claims significantly increased (5.4%–11.8%, p < 0.001), and days PPPM lost due to STD and associated wage loss PPPM numerically increased (0.15–0.25, p = 0.057 and $38–$60, p = 0.087). Conclusions: Following AML diagnosis, the proportion of patients with STD and LTD leave increased significantly, while absenteeism did not change significantly. Days of STD leave also increased among caregivers. Future research is needed to determine how work loss varies by AML treatment type and/or sequencing.

Work Loss and Direct and Indirect Costs Associated with Parkinson's Disease.

To examine work loss and indirect costs during the three-year periods prior to and following initial diagnosis of Parkinson's disease (PD) in patients and in spouses of PD patients, as well as direct costs of healthcare. This is a retrospective, observational cohort study using the MarketScan Commercial and Health and Productivity Management databases. A total of 286 employed PD patients and 153 employed spouses met all diagnostic and enrollment criteria for short-term disability (STD) analysis (PD Patient cohort and Caregiving Spouse cohort). The proportion of PD patients having a STD claim increased from roughly 5% and plateaued at around 12-14% starting in the year prior to first diagnosis of PD. The mean number of days lost from work due to STD per year increased from 1.4 days in the 3rd year prior to diagnosis to 8.6 days in the 3rd year after diagnosis (corresponding to an increase in indirect costs from $174 to $1104). STD use for spouses of patients with PD was lowest in the year after their spouses were diagnosed and then rose dramatically in the 2nd and 3rd years after the spouse's diagnosis. Total all-cause direct health-care costs increased during the years leading up to PD diagnosis and were highest in the years following diagnosis, with PD-related costs contributing ~20-30% of the total. PD has both a significant direct and indirect financial burden on patients and their spouses when analyzed for 3 years before and after diagnosis.

Productivity loss outcomes and costs among patients with cholangiocarcinoma in the United States: an economic evaluation

BackgroundCholangiocarcinoma (CCA) is associated with poor prognosis. Healthcare-related management likely presents a substantial economic burden associated with time away from work in patients with CCA.ObjectivesTo assess productivity loss, associated indirect costs, and all-cause healthcare resource utilization and costs owing to workplace absenteeism, short-term disability, and long-term disability in CCA patients with work absence and disability benefits eligibility in the United States.MethodsUS retrospective claims data from Merative MarketScan Commercial and Health and Productivity Management Databases. Eligible patients were adults with ≥1 non-diagnostic medical claim for CCA in the index period (1 January 2011–31 December 2019) and had ≥6 months of continuous medical and pharmacy benefit enrolment before and ≥1 month of follow-up and full-time employee work absence and disability benefits eligibility after the index date. Outcomes were assessed in patients with CCA, intrahepatic CCA (iCCA), and extrahepatic CCA (eCCA) in absenteeism, short-term disability, and long-term disability cohorts (measured per patient per month [PPPM] for a month of 21 workdays), with costs standardized to 2019 USD.ResultsOne thousand and sixty-five patients with CCA were included (iCCA: n = 624 [58.6%]; eCCA: n = 380 [35.7%]). The mean age was 51.9–53.9 years across cohorts. In patients with iCCA and eCCA, respectively, the number of mean all-cause days absent PPPM for illness was 6.0 and 4.3, and 12.9 and 6.6% had ≥1 CCA-related short-term disability claim. Median indirect costs PPPM owing to absenteeism, short-term disability, and long-term disability, respectively, in patients with iCCA were $622, $635, and $690, and $304, $589, and $465 in patients with eCCA. Patients with iCCA vs. eCCA had higher inpatient, outpatient medical, outpatient pharmacy, and all-cause healthcare costs PPPM.ConclusionsPatients with CCA had high productivity losses, indirect costs, and medical costs. Outpatient services costs contributed greatly to the higher healthcare expenditure observed in patients with iCCA vs. eCCA.

Differences in Modified-Return-to-Work by Immigration Characteristics Among a Cohort of Workers in British Columbia, Canada.

Introduction To investigate differences in modified-return-to work (MRTW) within the first 30 days of a work-related, short-term disability injury by immigration characteristics. This question was part of a program of research investigating differences in work and health experiences among immigrant workers and explanations for longer work disability durations. Methods Workers' compensation claims, immigration records and medical registry data were linked to identify a sample of workers in British Columbia, Canada with a short-term disability claim for a work-related back strain, concussion, limb fracture or connective tissue injury occurring between 2009 and 2015. Multivariable logistic regressions, stratified by injury type, investigated the odds of MRTW, defined as at least one day within the first 30 days on claim, associated with immigration characteristics, defined as a Canadian-born worker versus a worker who immigrated via the economic, family member or refugee/other humanitarian classification. Results Immigrant workers who arrived to Canada as a family member or as a refugee/other immigrant had a reduced odds of MRTW within the first 30 days of work disability for a back strain, concussion and limb fracture, compared to Canadian-born workers. Differences in MRTW were not observed for immigrant workers who arrived to Canada via the economic classification, or for connective tissue injuries. Conclusion The persistent and consistent finding of reduced MRTW for the same injury for different immigration classifications highlights contexts (work, health, social, language) that disadvantage some immigrants upon arrival to Canada and that persist over time even after entry into the workforce, including barriers to MRTW.

Lost work days associated with long COVID among healthcare workers

Background and aims: Long COVID among healthcare workers may have an important impact on productivity. Our aim was to analyze lost work days (LWD) related to long COVID among healthcare workers. Methods: We analyzed data from n=2,330 healthcare workers from the Mexican Social Security Institute previously diagnosed with SARSCoV-2, that submitted at least one short term disability claim (STDC) for a post-COVID symptom (April 2020-August 2021). Outcome was the sum of LWD for main reported post-COVID symptom for STDC submitted. Post-COVID symptoms included those reported by the literature at the time of the study, and categorized as: circulatory, kidney and liver symptoms (CKL), mental and behavioral disorders (MB), nervous system symptoms (NS) and respiratory symptoms (RS). We used linear regression to model adjusting for age, sex, work category (assistant to COVID attention (REF), direct COVID-patient contact and, administrative/no COVID attention), hospitalization due to SARSCoV-2 infection, having a STDC previous to SARSCoV-2 with the same post-COVID symptom and if the STDC was classified as work-related. Results: Participants had a mean age of 41±9 years and 70% were women. MB were most frequent (45%), followed by RS (30%), CKL (14%) and NS (11%). LWD were on average of 23±39 and n=312 participants submitted more than one STDC. Compared to RS, all categories were associated with increased LWD, NS: ß= 17.26 (95% CI: 2.46, 14.89), CKL: ß= 8.51 (95% CI: -3.49, 13.53) and MB: ß= 8.08 (95% CI: 4.36, 11.79). Sex was not associated with LWD, whereas all covariates were associated with increasing LWD, with work-related STDC classification having the strongest association (ß= 24.14, 95% CI: 17.42, 30.86). Conclusions: LWD due to long COVID among healthcare workers increased the most among those with NS and especially for STDC classified as work-related. Keywords: long COVID, healthcare workers, lost work days.

Tracking the SARS-CoV-2 Omicron (B. 1.1. 529) health and economic impact by occupational sector

Background: Real-time outbreak patterns during the COVID-19 pandemic have been crucial to provide quick response, prevention and attention programs. Workers reflect a country’s population, hence, paid sick leaves (short-term disability claims, STDC) can track epidemics, including the current pandemic. Our aim was to assess the impact of Omicron by occupational sector/subsector among N=19,961,714 private-sector workers affiliated to the Mexican Social Security Institute. Methods: We used STDC that had a linked SARS-CoV-19 diagnostic test between January and March 4, 2022. There were n=1,543,730 STDC and n=663,245 of them with a test. We calculated the positivity rate, lost work days (LWD), and relative risks (RR) of Omicron vs the same epidemiological weeks for the first, second and Delta COVID waves by economic sector/subsector. Results: Workers were 36±10.7 years old and 47% were men. We saw an 85.4% positivity rate, with an average of 6.8±3 LWD, representing 528.3 LWD per 1,000 workers. The RR of Omicron was highest compared to the first wave (RR= 1.84; 95%CI: 1.83, 1.84) with the Accommodation (RR= 3.98; 95%CI: 3.89, 4.07) and Educational Services-arts-entertainment-recreation (RR= 2.41; 95%CI: 2.37, 2.46) sectors having the highest RRs. The RR of Omicron vs Delta was the next highest RR= 1.29; 95%CI: 1.29, 1.29) with Health Care and Social Assistance (RR= 2.15; 95%CI: 2.12, 2.19) and Social and Community Services (RR= 1.79; 95%CI: 1.78, 1.81) having the highest RR. Omicron vs the second wave had a RR of 1.07; 95%CI: 1.07, 1.07, with Accommodation (RR= 1.40; 95%CI: 1.38, 1.41) and Educational Services-arts-entertainment-recreation (RR= 1.60; 95%CI: 1.57, 1.62) sectors having the highest RRs. Conclusions: Omicron spread more effectively than the previous COVID-19 and Delta waves in Mexico, affecting the touristic and health care sectors more importantly, reflecting the entrance of the variant to the country through tourism. Keywords: Omicron impact, occupational sector, Mexico

Use of Private Sector Workforce Respiratory Disease Short-Term Disability Claims to Assess SARS-CoV-2, Mexico, 2020

Abstract We examined respiratory disease short-term disability claims submitted to the Mexican Social Security Institute during 2020. A total of 1,631,587 claims were submitted by 19.1 million insured workers. Cumulative incidence (8.5%) was 3.6 times higher than that for January 2015‒December-2019. Workers in healthcare, social assistance, self-service, and retail stores were disproportionately affected.

Use of Private Sector Workforce Respiratory Disease Short-Term Disability Claims to Assess SARS-CoV-2, Mexico, 2020.

We examined respiratory disease short-term disability claims submitted to the Mexican Social Security Institute during 2020. A total of 1,631,587 claims were submitted by 19.1 million insured workers. Cumulative incidence (8.5%) was 3.6 times higher than that for January 2015‒December-2019. Workers in healthcare, social assistance, self-service, and retail stores were disproportionately affected.

Productivity Loss and Indirect Costs Among Non-Hodgkin Lymphoma Patients and Their Caregivers

Introduction: The impact of cancer care and management beyond treatment is significantly high for cancer patients. Due to the complexities of cancer treatment, patients are heavily reliant upon ancillary support often rendered by friends and family. One significant yet unquantifiable impact of cancer on society is productivity loss of both patients and their caregivers. Non-Hodgkin lymphoma is considered largely incurable with a protracted clinical course punctuated with multiple remission and relapses, warranting repeated treatment and intensive clinical testing, which necessitates significant engagement of patients and caregivers. Many patients are members of the workforce at the age of diagnosis. Both working patients and caregivers need time for medical care, which translates to indirect economic impact due to lost productivity. The objectives of this analysis were to evaluate the productivity loss and indirect costs in patients with chronic lymphocytic leukemia (CLL), mantle cell lymphoma (MCL), marginal zone lymphoma (MZL), or Waldenström macroglobulinemia (WM) and their caregivers.Methods: The MarketScan Commercial and Health and Productivity Management databases were used to identify patients with CLL, MCL, MZL, and WM (using ICD-9/ICD-10 codes) who were continuously enrolled for ≥6 months pre- and ≥1 month post-diagnosis (index date) from 1/1/2010 to 12/31/2019. The final study cohort included patients aged 18-64 who were full-time workers with eligibility of absentee, or short-/long-term disability on index date and for ≥1 month in follow-up. Those who were pregnant during the study period were excluded. Adult, full-time employed caregivers, defined as family members covered under the same health plan as the patient, and continuously enrolled ≥6 months pre- and ≥1 month post-index, were also identified. Among those with eligibility, the percentage with a claim of absentee, short- or long-term disability (patients only), and associated productivity time loss and indirect costs during follow-up were examined. Lost wages were calculated using the US Bureau of Labor Statistics 2019 report. For short- or long-term disabilities, mean daily wages were reduced to 70% of typical wages. Productivity time loss and costs were reported per-patient-per-month (PPPM) for each lymphoma.Results: The final patient cohort included 3,450 CLL, 448 MCL, 1,052 MZL and 394 WM patients; the caregiver cohort included 1,435 CLL, 171 MCL, 437 MZL and 190 WM caregivers. Among eligible patients, there were higher proportions of patients that had absentee claims (CLL, 76%; MCL, 72%; MZL, 72%; WM, 82%), followed by short-term disability (CLL, 16%; MCL, 36%; MZL, 18%; WM, 17%) and long-term disability (CLL, 3%; MCL, 10%; MZL, 3%; WM, 3%) (Figure 1A). The proportions of caregivers with absentee claims (CLL, 78%; MCL, 90%; MZL, 69%; WM, 75%) were also higher than those with short-term disability (CLL, 7%; MCL, 10%; MZL, 4%; WM, 8%) (Figure 1B). For all 4 lymphoma types, average illness-related absentee hours were higher in patients than caregivers (CLL, 9.5 vs 6.9; MCL, 44.5 vs 3.6; MZL, 17.0 vs 5.0; WM, 18.2 vs 8.1). A similar pattern was observed for short-term disability days (CLL, 6.9 vs 4.2; MCL, 10.8 vs 3.4; MZL, 7.0 vs 2.2; WM, 6.7 vs 4.8). Average PPPM indirect costs were higher for patients with long-term disability (CLL, $1,433; MCL, $1,233; MZL, $1,302; WM, $2,056) than with short-term disability (CLL, $1,203; MCL, $1,950; MZL, $1,145; WM. $1,177) or absentee claims (CLL, $365; MCL, $1,606; MZL, $612; WM, $662), except for patients with MCL (Figure 2A). Similar trends were observed among caregivers, though the indirect costs due to absenteeism and short-term disability were higher in patients than caregivers (Figure 2B).Conclusions: This real-world evidence study uncovered patients with CLL, MCL, MZL and WM and their caregivers incur substantial disease burden as shown by their productivity loss and indirect costs. Effective treatments that can offer a cure or better remission rates and shorter duration with less toxicity may not only enhance the patients and caregivers' quality of life but also reduce work loss. The availability of oral, targeted therapies has resulted in higher remission rates, durable responses, manageable toxicities and improved quality of life in trials. Future studies are needed to understand the impact of these oral, targeted therapies on patients' and caregivers' productivity. [Display omitted] DisclosuresYang: BeiGene, Ltd.: Current Employment. Liu: BeiGene, Ltd.: Current Employment. Irwin: IBM Watson Health: Current Employment; BeiGene, Ltd.: Consultancy. Packnett: IBM Watson Health: Current Employment; BeiGene, Ltd.: Consultancy. Lew: BeiGene, Ltd.: Consultancy; IBM Watson Health: Current Employment. Noxon: BeiGene, Ltd.: Consultancy; IBM Watson Health: Current Employment. Tang: BeiGene, Ltd.: Current Employment. Chanan-Khan: BieGene, Jansen, Ascentage: Consultancy; BeiGene, Jansen, Ascentage: Honoraria; Alpha2 Pharmaceuticals: Patents & Royalties: Tabi; Cellectar: Current equity holder in publicly-traded company; Ascentage, Starton, Cellectar, NonoDev, Alpha2 Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees; Alpha2 Pharmaceuticals, NonoDev, Starton: Current holder of stock options in a privately-held company; Ascentage: Research Funding.

Work Absence Following COVID-19 Vaccination in a Cohort of Healthcare Personnel.

Objective:To identify rates of work absence following receipt of COVID-19 vaccine in a cohort of healthcare personnel (HCP).Methods:Short-term disability (STD) usage by HCP attributed to side effects of the COVID-19 vaccine was calculated for each vaccine manufacturer, job category, age group, and work region. Analysis was performed for the cohort of HCP during the initial vaccination campaign.Results:4.1% of COVID-19 vaccinations generated a STD claim for lost work due to side effects, with increased STD rates after dose 2 than dose 1 (7.4% and 0.9%, respectively). Rates were higher for younger HCP and allied health staff.Conclusions:While side effects from mRNA vaccine dose 2 resulted in more work absence, statistically significant geographic differences in STD suggest cultural and staffing factors may impact HCP to utilize STD following vaccination.

SARS-CoV-2 pandemic among Mexico´s private sector workforce: using short-term disability claims to analyze impact and response

BACKGROUND AND AIM: The COVID-19 pandemic has affected workforces around the world, on both the individual and business levels. This impact has not yet been described adequately. AIM: To analyze the impact of COVID-19 among workers and businesses using short term disability claims (STDC). METHODS: Our analysis is derived from the national data base STDC submitted to the Mexican Institute of Social Security (the largest health care and benefits provider) by private-sector workers and eligible government-owned companies. We analyzed absenteeism trends evaluated through respiratory diseases-STDC (RD-STDC) among the different occupational sectors for 19,112,620 workers registered up to December 31, 2020. RESULTS:A total of 1,543,600 workers claimed at least one RD-STDC. Up to year week 53, 1.7 million RD-STDC were reported, with an estimated cumulative incidence of 8.0%. The mean age of workers was 35.2 years (Interquartile Range [IQR] = 26- 43 years); 53.4% were male. The average duration of the STD granted was 10.1 days [IQR= 3 - 14 days]. Higher RD-STD-attack rates were observed in Trade (9.9%) and Manufacturing (9.8%). Health care-related subsectors had RD-STDC attack rates of 15.1% for private health care workers. During 2020, 16.9 million total workdays were lost. Real symptomatic COVID-19 attack rates could be 3 or 4 times higher. CONCLUSIONS:Our findings point to the necessity of establishing an integrated surveillance system in which STDC can help geo-localize chains of contagion that would otherwise proliferate undetected. Information provided by this system will complement surveillance systems for monitoring epidemics and informing decision-making of by health authorities. KEYWORDS: Short term disability claims, COVID-19, occupational, Mexico

Costs Associated with Productivity Loss Among U.S. Patients Newly Diagnosed with Multiple Myeloma Receiving Oral Versus Injectable Chemotherapy

BackgroundThe use of novel Multiple Myeloma (MM) drug agents has been associated with improved therapeutic outcomes and survival; however, MM continues to pose a significant economic burden on both patients and healthcare systems. Evaluating the economic implications and outcomes of available treatments is important to improve efficiency of care.Patients with MM may experience productivity loss, including lost days from work or inability to work due to MM symptoms or to undergoing treatment. Although direct costs of illness have been well described in the literature, indirect costs associated with MM are understudied. Here, we examine the extent of workplace productivity loss among U.S. adult patients with MM and associated costs. These outcomes were compared among patients who received injectable versus oral MM therapy.MethodsAnalyses were conducted using the Truven Health Analytics MarketScan Commercial Claims and Encounters with Medicare Supplemental Coordination of Benefits and Health and Productivity Management Databases. Subjects at least 18 years of age diagnosed with MM between January 1, 2008 and December 31, 2014 were included in our study and followed until December 31, 2015 (Figure 1). Subjects were analyzed one year prior to, and one year following first MM diagnosis. Patients receiving only oral therapy were compared with those who received injectable therapy.Productivity loss was evaluated using several key variables found within workplace absenteeism (WAB), short-term disability (STD), and long-term disability (LTD) claim files. Workplace productivity loss (WPL), an aggregate of absenteeism days, was calculated using claims for WAB, STD, and LTD benefits. Cost of productivity loss was calculated for each patient by multiplying the number of absenteeism days (as indicated in the aggregate WPL measure) by the average daily wage for all occupations, as reported by the U.S. Bureau of Labor Statistics (Table 1).Absenteeism days and costs were compared among study groups using multi-variable zero-inflated Poisson regression. The following variables were used as covariates in the model: age, index year, gender, Charlson comorbidity index, and plan type. An interrupted time-series analysis was also conducted to evaluate changes in productivity losses in the pre- vs. post-diagnosis periods, and to compare these among the treatment groups.ResultsThe final study cohort included 299 patients with newly diagnosed MM, of whom 73 received oral therapy and 226 received injectable therapy. Baseline characteristics of the study groups are depicted in Table 2. In the zero-inflated Poisson regression, treatment type was a significant predictor of productivity loss (Figure 2). Patients who received injectable therapy missed an average of 110 work days in the one year post-diagnosis, compared with 88 for patients receiving only oral therapy (difference of 22 days, 95% CI: 19 - 25, p<0.001). Treatment type was also a significant predictor of cost of lost productivity in this model (Figure 3). Patients who received injectable therapy experienced productivity loss valued at $18,329, compared with patients who only received oral drug therapy ($14,467). The difference in valuated productivity losses between study cohort groups was also statistically significant ($3,862, 95% CI: $3,518 - $4,205, p<0.001).An interrupted time-series analysis showed a significant increase in missed work days per month following the initial diagnosis of MM for both treatment groups. Patients receiving injectable therapy experienced an immediate increase of 6.9 lost productivity days per month (95% CI: 5.1, 8.7, p<0.001), versus patients receiving oral therapy only (4.4 days per month; 95% CI: 2.7, 6.2, p<0.001). The difference in these values was not statistically significant, although a strong trend was observed (2.5 day per month; 95% CI: -0.1, 5.0, p=0.057).ConclusionsIn conclusion, patients newly diagnosed with MM face significant losses in productivity. Injectable MM therapy users experience significantly more utilization of disability benefits and incur higher productivity costs, compared to oral MM therapy users. Further studies elucidating the nature of the differences between parenteral and non-parenteral chemotherapy users are needed. [Display omitted] DisclosuresMerola:Millennium Pharmaceuticals, Inc.: Consultancy. Yong:Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment. Noga:Millennium Pharmaceuticals, Inc., Cambridge, MA, USA, a wholly owned subsidiary of Takeda Pharmaceutical Company Limited: Employment. Shermock:Millenium Pharmaceuticals: Consultancy.

PGI25 Long- and Short-Term Disability and Workers' Compensation Trends for Employees with Digestive System (Gastrointestinal) Conditions in the United States

Use objective data to compare patients’ all-cause short-term disability (STD), long-term disability (LTD) and workers' compensation (WC) utilization and explore changes from baseline for employees with gastrointestinal (digestive system) conditions. Employees with gastrointestinal medical-claims in the US Agency for Healthcare Research and Quality digestive system category were retrospectively identified in WorkPartners Research Reference Database(RRDb) from 2001—2019. Each year the analysis focused on the percent of patients with gastrointestinal-conditions, and by absence benefit, the percent of eligible employees utilizing the benefit, mean leave-length (days) and median payments as percent of salary (MedianPay). Disability+WC payments included lump-sum distributions and potentially extended beyond the year initially incurred. Workplace accidents were paid under the WC benefit. WC claims without absence from work (medical-only) were excluded. Sick leave claims may be taken for any reason and were excluded. All employees’ absences were aggregated based on the initiation-year. For each benefit, average leave-length and MedianPay were calculated and compared with baseline(2001). At baseline (2001), 8.4% of employees had gastrointestinal conditions; of these, 12.4% filed STD-claims lasting 37.53 mean-days at 70.5% MedianPay, 0.5% filed LTD-claims lasting 194.27 mean-days at 19.6% MedianPay, and 1.5% filed WC-claims lasting 53.99 mean-days at 67.2% MedianPay. From 2002—2019, 7.1%—10.2% of employees had gastrointestinal conditions. Of these, 10.4%—16.5% of eligible employees filed STD claims lasting 80.8%—119.8% of baseline-days (BDs) and paying 68.6%—127.7% MedianPay; 0.6%—1.4% of eligible employees filed LTD claims lasting 61.2%—368.0% of BDs at 115.1%—305.7% MedianPay; 0.5%—1.5% of eligible employees filed WC claims lasting 128.1%—327.6% of BDs at 78.3%—175.6% MedianPay. MedianPay was highest in 2013(STD), 2002(LTD), and 2003(WC). Claims-lengths were longest in 2019(STD), and 2006(LTD) and 2010(WC). Employees with gastrointestinal diseases used different absence benefits over time with varying leave lengths and payments as a percent of salary. Using a constant cost over time for all benefits is not accurate or appropriate.

Evaluation of disability in patients exposed to fluoroquinolones

BackgroundFluoroquinolones are used for conditions including sinusitis, bronchitis, and urinary tract infections. It has been suggested that exposure to fluoroquinolones for these conditions is associated with disability resulting from adverse events in 2 or more organ systems. The objectives were to: describe: 1) fluoroquinolone, azithromycin, and sulfamethoxazole / trimethoprim utilization for these infections; 2) the rate of disability associated with exposure to each of these antibiotic classes and adverse events in 2 or more system organ classes, and 3) compare outcome rates for each of the antibiotic classes.MethodsThis study was conducted using administrative data to mitigate the limitations of spontaneous reports. The sampling frame was a U.S. population with both medical and disability insurance, including patients with the above uncomplicated infections who were prescribed the antibiotics of interest.The primary outcome was an incident short-term disability claim associated with adverse events in 2 different organ systems within 120 days of exposure. A matched analysis was used to compare the outcome for patients receiving each of the drug classes.ResultsAfter propensity score matching, there were 119,653 individuals in each of the exposure groups. There were 264 fluoroquinolone associated disability events and 243 azithromycin/ sulfamethoxazole associated disability events (relative risk =1.09 (95% CI: 0.92–1.30; calibrated p = 0.84)). The results were not significantly different from the null hypothesis of no difference between groups.ConclusionComparative assessments are difficult to conduct in spontaneous reports. This examination of disability associated with adverse events in different system organ classes showed no difference between fluoroquinolones and azithromycin or sulfamethoxazole in administrative data.

ND3 SHORT- AND LONG-TERM DISABILITY BURDEN AMONG EMPLOYED PATIENTS RECEIVING DISEASE-MODIFYING TREATMENT FOR MULTIPLE SCLEROSIS

This study examined the short-term disability (STD) and long-term disability (LTD) burden (as measures of severe productivity loss) among employees with multiple sclerosis (MS) initiating disease-modifying treatments (DMTs). Using the IBM MarketScan Commercial Claims and Health and Productivity Management Database, patients with ≥2 new MS claims (≥1 and <365 days apart) between January 1, 2009, and January 1, 2017, and 1 subsequent claim for a DMT (index date) were identified. Patients had ≥12 months of continuous enrollment pre-index, ≥1 full calendar year of STD and/or LTD eligibility (accessible to active employees only), and no evidence of pregnancy or malignancy during the study period. The number and duration of all STD and/or LTD claims were captured during all calendar years of follow-up. A total of 3,023 patients initiating orals (25.5%), injectables (64.1%), or infusions (6.1%) were identified (mean age: 41.4 years; female: 62.1%). In the first year, the percentage of patients with STD claims was generally similar across routes of administration (total: 23.2%; orals: 21.7%; injectables: 23.4%; infusions: 27.7%), as were STD days per patient with a claim (68.8, 69.9, 68.8, and 64.6 days, respectively). Percentages of patients with LTD claims were low (total: 3.1%; orals: 3.7%; injectables: 2.9%; infusions: 2.8%). Oral DMT initiators had the lowest number of LTD days per patient (31.7 days), with a numerically lower number of days compared with infusions (45.8 days) and a significantly lower difference compared with injectables (76.3 days; P=0.0307). Productivity loss burden was high in the first year in MS patients. Oral DMT initiators had the lowest percentage of short-term disability claims and days per long-term disability claim, suggesting productivity benefits in severe productivity loss with early access to orals. Additional research is needed to better quantify this benefit.

Evaluating direct costs and productivity losses of patients with asthma receiving GINA 4/5 therapy in the United States

BackgroundDespite the low prevalence for all patients with asthma, those with severe disease account for a disproportionately large economic burden. ObjectiveTo evaluate current direct health care and productivity loss costs associated with patients with asthma receiving Global Initiative for Asthma Step 4/5 therapy (“G4/5 asthma”) in the United States. MethodsAsthma patients aged 12 years or older were identified in the IBM MarketScan Research Databases between January 1, 2012 and December 31, 2015. Patients were indexed on their earliest medical claim for asthma and were required to have at last 2 years of continuous eligibility. The G4/5 asthma classification required 1 or more medium- or high-dosage inhaled corticosteroids (ICS)/long-acting beta-agonist (LABA) claims, 1 or more omalizumab claims, or systemic corticosteroids covering at least 50% of the 12-month baseline period. The European Respiratory Society/American Thoracic Society criteria for severe uncontrolled asthma were modified for claims data and used to identify patients with exacerbations or high rescue medication use (“Ex/R″). Direct health care costs and productivity loss costs attributable to workplace absence or short-term or long-term disability were measured during the 12-month post-index period. ResultsA total of 605,614 patients with asthma were identified. Annual health care costs were $4,384 greater for G4/5 asthma vs non-G4/5 patients with asthma; asthma-related costs contributed $2,183 of this difference (P < .001). Differences were primarily driven by G4/5 patients with asthma with Ex/R, whose costs were $5,019 greater than G4/5 patients without Ex/R (P < .001). For patients with 1 or more absences or short-term disability claims, G4/5 patients missed 7.2 more work hours for absence and had 3.9 more days of work lost for short-term disability than non-G4/5 patients with asthma, respectively (P < .05). ConclusionG4/5 patients with asthma incurred significantly greater direct and indirect costs than non-G4/5 patients with asthma. Differences were largely driven by those with Ex/R.