Objective measurement of work absence and on-the-job productivity: a case-control study of US employees with and without gastroesophageal reflux disease

Meta-analysis of the efficacy and safety of pantoprazole in the treatment and symptom relief of patients with gastroesophageal reflux disease - PAN-STAR

INTRODUCTION

Proton pump inhibitors therapy success in the treatment of gastroesophageal reflux disease (GERD) is a difficult task because the extent of mucosal damage has no relation with the severity of the symptoms.

AIM

To establish the efficacy of pantoprazole treatment in patients with erosive reflux disease (ERD) and in those with non-erosive reflux disease (NERD), by assessing symptom relief and quality of life. Treatment duration and adverse events associated with pantoprazole treatment were analysed.

MATERIAL AND METHODS

This meta-analysis was based on three multicentre, prospective, open-label, phase IV trials conducted in Slovenia, Poland, and the Russian Federation. In total, 252 patients with GERD were included and treated with pantoprazole 40 mg once daily for 4 or 8 weeks, depending on the fulfilment of predefined healing criteria. Symptoms were assessed by patients on a scale from 0 to 3 and the quality of life on a rating scale from 1 to 10.

RESULTS

Forty-five percent of patients fulfilled the healing criteria after 4 weeks of treatment, and 70% of patients after 8 weeks of treatment. Patients who failed to reach the healing criteria reported significant reduction of symptoms severity. The response to 8-week treatment was significantly higher in patients with ERD (76%) when compared to patients with NERD (64%). Discontinuation of treatment after 4 weeks was not associated with worsening of symptoms and did not affect quality of life. Pantoprazole treatment was associated with improvement of symptoms and the quality of life of GERD patients over 8 weeks of treatment and showed that GERD patients with persisting symptoms benefit from prolonging treatment to 8 weeks. Treatment with pantoprazole 40 mg was very well tolerated - more than 90% of patients were without adverse events throughout the whole study and only 4 patients discontinued the treatment due to adverse events related to pantoprazole treatment.

CONCLUSIONS

Pantoprazole 40 mg was associated with complete relief of GERD-related symptoms in the majority of patients with ERD and NERD. Furthermore, the severity of symptoms was significantly reduced in patients without complete relief of symptoms. Pantoprazole also continuously improved the quality of life of GERD patients over 8 weeks of treatment and was very well tolerated throughout the whole study. Therefore, this meta-analysis suggests that pantoprazole 40 mg once daily is an effective and well-tolerated choice for providing symptom relief of patients with GERD.

Sickness absence due to gastroesophageal reflux diagnoses: a nationwide Swedish population-based study

OBJECTIVE

Gastroesophageal reflux disease (GERD) is a major public health problem in the Western world. No previous population-based nationwide study has, however, examined the occurrence of sickness absence due to GERD diagnoses, that is, the aim of this study.

MATERIAL AND METHODS

Nationwide population-based study based on Swedish registers including all 4,764,843 individuals registered as living in Sweden in 31 December 2004 and 31 December 2005, aged 20-64 years, not on disability or old age pension. Reimbursed sickness absence due to reflux diagnoses (ICD-10), that is, GERD (K21), esophagitis (K20), and heartburn (R12), was studied separately and combined. In analyses stratified by sociodemographic factors, inpatient/specialized outpatient care, antireflux surgery, and prescribed reflux medications those sickness absent in 2005 due to reflux diagnoses were compared to those sickness absent due to non-reflux diagnoses and to those with no sickness benefits 2005.

RESULTS

In total, 627 individuals had at least one prevalent sick-leave spell due to reflux diagnoses in 2005, of which GERD was the most common diagnosis. Of these, almost half (45%) was absent for ≥ 28 reimbursed sick-leave days due to reflux diagnoses. The proportions of low socioeconomic status (SES), inpatient and outpatient care due to tumors, mental disorders, circulatory disorders, GERD, antireflux surgery, and reflux medications were higher among those sickness absent due to reflux diagnoses compared to those with no sickness benefits.

CONCLUSIONS

In this nationwide population-based study a high proportion of those sickness absent due to reflux diagnoses was on long-term sick leave, a finding that warrants attention.

Partial response to proton pump inhibitor therapy for GERD: observational study of patient characteristics, burden of disease, and costs in the USA

Background

Disease burden and associated costs are not well understood among patients with gastroesophageal reflux disease (GERD) who have persistent symptoms despite optimized proton pump inhibitor (PPI) therapy. The aim of this study was to investigate disease burden and costs of GERD in partial responders to PPI therapy.

Methods

The Partial Response to PPI treatment: the Cost to Society and the Burden to the Patient in the US (REMAIN US) study was a 12-month, multicenter, noninterventional, observational study of 552 partial PPI responders in the USA. Participating sites were comprised of family practice (n = 30), internal medicine (n = 8), and specialist (gastroenterologist) centers (n = 15). GERD symptoms, health-related quality of life (HRQL), and impact on productivity were evaluated from patient-reported outcome instruments. Resource utilization data were also collected.

Results

Patients had a high symptom burden, impaired HRQL, and reduced productivity while at work and in daily activities, despite optimized PPI therapy. Mean annual GERD-related costs were US$9944 per patient, comprising total direct costs and mean productivity loss costs of US$4068 and US$5876 per patient, respectively.

Conclusion

Patients with GERD and a partial response to PPI therapy have considerable direct and indirect costs, along with substantial impairments in HRQL and productivity.

Burden of gastro-oesophageal reflux disease in patients with persistent and intense symptoms despite proton pump inhibitor therapy: A post hoc analysis of the 2007 national health and wellness survey

BACKGROUND AND OBJECTIVE

Research on the negative impact of gastro-oesophageal reflux disease (GORD) on the health-related quality of life (HR-QOL) and resource utilization of patients with persistent and intense GORD symptoms despite proton pump inhibitor (PPI) therapy is lacking. The aim of this study was to describe the population of patients with GORD with persistent moderate-to-severe symptoms despite ongoing PPI therapy, and to compare their HR-QOL and healthcare resource use with patients with low GORD symptom load during ongoing PPI therapy.

METHODS

In this post hoc analysis of the 2007 National Health and Wellness Survey (NHWS), PPI-compliant (≥22 days with PPI use in the past month) European (France, Germany and the UK) and US respondents with physician-diagnosed GORD were stratified into those with persistent and intense GORD symptoms, those with low symptom load, or an intermediate group.

RESULTS

5672 PPI-compliant respondents were identified (persistent and intense symptoms, n = 1741; low symptom load, n = 1805; intermediate group, n = 2126). Respondents with persistent and intense symptoms had poorer HR-QOL than patients with a low symptom load, but none of the differences were statistically significant. Respondents with persistent and intense symptoms also reported lower work productivity (all countries; significant difference [p < 0.01] only in the US), greater activity impairment (all countries; significant difference [p < 0.01] only in the US) and more hours missed from work due to health problems (US, UK and Germany; significant difference [p < 0.01] only in the US). In the UK and US, respondents with persistent and intense symptoms reported significantly more visits to both primary-care physicians and specialists than respondents with a low symptom load (all p < 0.01). Additionally, US respondents with persistent and intense symptoms reported significantly more emergency room visits (p < 0.01).

CONCLUSION

The 2007 NHWS gives support to the hypothesis that persistent and intense GORD symptoms despite PPI therapy have a significant and negative impact on both HR-QOL and healthcare resource utilization. These findings outline the need for new treatment options for symptomatic GORD patients taking PPI therapy.

Economic impact to employers of treatment options for cardiac arrhythmias in the US health system

OBJECTIVE

To measure relative employer-sponsored postablation costs for cardiac arrhythmias (CA), specifically atrial fibrillation (AF).

METHODS

Regression-Controlled Employee/Spouse Database study (2001 to 2008) comparing CA patients with and without ablation and AF patients with and without ablation. Regression-adjusted monthly medical, pharmacy, sick leave, and short-term disability costs were calculated 11 months before index to 36 months after index (first ablation date or average date for nonablation patients). Relative pre/postindex comparisons between ablation and nonablation cohorts were calculated and time until ablation procedure cost recovery extrapolated.

RESULTS

Few CA (280 of 11,291; 2.48%) and AF (93 of 3062; 3.04%) patients received ablation. Ablation cohorts cost less than nonablation cohorts postablation. Estimated total ablation-period costs were recovered 38 to 50 months postablation, including employee absence payment recovery within 18 months.

CONCLUSION

Current ablation use in employer-sponsored health plans may improve health care and absence costs over time.

Economic burden of gastro-oesophageal reflux disease and dyspepsia: A community-based study

BACKGROUND AND STUDY AIMS

Gastro-oesophageal reflux disease (GERD) and dyspepsia are common digestive disorders that inflict serious harm, burden and economic consequences on individuals worldwide. The aim of this study was to estimate the direct and indirect economic burden of GERD and dyspepsia in the whole population of Tehran, the capital of Iran.

PATIENTS AND METHODS

The study was performed on a total of 18,180 adult subjects (age>18 years) taken as a random sample in Tehran province, Iran (2006-2007). A valid and reliable questionnaire was used to enquire about the symptoms of GERD, dyspepsia and the frequency of the utilization of health services including physician visits, hospitalisations and productivity loss due to GERD/dyspepsia symptoms in the preceding 6 months.

RESULTS

GERD was found in 518 (41.9% males) patients and dyspepsia in 404 patients (38.9% males). Further 1007 subjects had both GERD and dyspepsia. The total direct costs of disease per patient for GERD, dyspepsia and their overlap were PPP$97.70, PPP$108.10 and PPP$101.30, respectively (PPP, purchasing power parity dollars). The total indirect cost of disease per patient was PPP$13.7, PPP$12.1 and PPP$32.7, for GERD, dyspepsia and their overlap, respectively.

CONCLUSION

According to our results, hospitalisation and physician visits were the main cost of disease that could be minimised by revision of the insurance business in Iran.

Effects of structured follow-up and of more effective acid inhibitory treatment in the management of GORD patients in a Swedish primary-care setting: a randomized, open-label study

BACKGROUND

Despite the high prevalence of gastro-oesophageal reflux disease (GORD) and the documented impact of GORD symptoms on individual health-related quality of life (HR-QOL) and on socioeconomic factors, structured management of GORD has had a low priority in Swedish routine primary health care.

OBJECTIVE

The primary objective of this study (IMPROVE) was to evaluate the effects of a structured follow-up and management regimen for primary-care GORD patients with symptomatic breakthrough despite standard proton pump inhibitor (PPI) treatment. Patients received either an increased dose of current PPI treatment or were switched to the more effective acid inhibitor esomeprazole.

METHODS

GORD patients with symptomatic breakthrough despite standard PPI treatment were identified through medical records and by a postal survey using the GERD Impact Scale (GIS) questionnaire. Patients rated the severity and frequency of GORD symptoms, general health status (EuroQol Group 5-Dimension Self-Report Questionnaire) and the impact of GORD symptoms on work productivity (Work Productivity and Activity Impairment) before and 4 weeks following randomization to open-label treatment with either increased acid suppressive therapy or an adjusted, higher dosage of the PPI previously used. The patients' valuation, in monetary terms, of the treatment they received pre-study versus the treatment given during the study was documented through willingness-to-pay (WTP) questions.

RESULTS

Following more effective acid suppression, 66.3% of the study population experienced complete relief of heartburn, with no difference between the groups; HR-QOL was restored to a level comparable to that of a normal Swedish population and ability to work efficiently was significantly improved. Access to a better acid suppressive treatment was highly valuable to the patients in terms of WTP.

CONCLUSION

An improved GORD management strategy including structured follow-up of treatment given and initiation of more effective acid inhibitor therapy when symptoms persist will be of great benefit to GORD patients. [ClinicalTrials.gov Identifier: NCT00272701].

[Use of health resources and loss of productivity in gastroesophageal reflux disease: results of a cross-sectional study in a primary care setting in Spain]

OBJECTIVE

To evaluate healthcare resource use and productivity in patients with gastro-esophageal reflux disease (GERD) and the influence of disease severity on these two factors.

DESIGN

Sub-analysis of the Spanish population of a multinational study with a 4-month retrospective period for the identification and selection of patients, and a clinical visit to obtain clinical information and data on use of healthcare resources, carried out between October 2007 and January 2008.

POPULATION

A total of 477 patients attending a Primary Care centre, with a medical consultation for GERD.

MAIN VARIABLES

Use of healthcare resources, changes in productivity based on the Work Productivity and Activity Impairment Questionnaire for GERD patients (WPAI-GERD).

RESULTS

Despite having received pharmacological treatment at the baseline visit, after a median of 5.1 months follow-up (range 2.1-8.1), up to 15.9% (95% CI; 12.8-19.5) patients still showed clinically relevant GERD symptoms. Direct medical costs per year associated with diagnostic tests and medical consultations in patients with or without clinically relevant GERD symptoms were 666 € (SD: 2,097 €) and 370 € (SD: 2,060 €), respectively. The mean annual cost of reduced productivity (17%) was 5,316 € (SD: 8,615 €). This cost was 4 times higher for patients with clinically relevant GERD symptoms than for patients with no relevant symptoms (15,188 € [SD: 11,206 €] vs 3,926 € [SD: 7,232 €]).

CONCLUSION

Patients with GERD use significant healthcare resources, attributable to associated medical costs and marked reduction in productivity, even though they receive pharmacological treatment.

Comparing costs and absences for multiple sclerosis among US employees: pre- and post-treatment initiation

BACKGROUND

Limited data exist on the effects of Disease Modifying Treatments (DMTs) on direct and indirect costs among employees treated for Multiple Sclerosis (MS). The objective was to compare costs and absences among employees treated with DMTs (e.g., interferons [IFNs]: IFN-β1a-IM = Avonex = 'A', IFN-β1b = Betaseron = 'B', IFN-β1a-SC = Rebif = 'R', or glatiramer acetate = Copaxone = 'C') for MS pre and post therapy initiation.

METHODS

A healthcare claims database of US employees (2001-2008) was used to identify patients with two or more DMT prescriptions or one DMT prescription with a MS diagnosis (ICD-9 = 340.X) who were continuously employed and with health plan coverage 6 months pre and post DMT initialization. Outcome measures included: direct costs; indirect costs and absences associated with sick leave (SL) and short-term disability (STD); and medical costs and utilization by place of service (POS). All costs are inflation-adjusted to 2010 US$. Between- and within-group outcomes were compared using Student's t-tests for continuous and chi-square tests for discrete variables and considered significant when P ≤ 0.05.

RESULTS

Overall, 153 eligible employees were identified: 'A' = 68, 'B' = 22, 'R' = 21, 'C' = 42; 76 employees had SL eligibility; 89 had STD eligibility; and 97 employees had POS indicators. Following treatment initiation, healthcare costs decreased significantly for 'A' users (-53.8%, -$3084) and 'B' users (-67.1%, -$4103), while SL costs only decreased significantly for 'A' users (-60.5%, -$704); changes in SL absence days for 'A' and 'B' users were significantly lower than for 'C' users (both P < 0.05). In the POS sample, total medical costs significantly decreased for 'A' (-$3643), 'B' (-$3470), and 'C' (-$3762), while 'R' increased ($2093) non-significantly. Only 'A' users had significant proportion-of-care reductions (Emergency Department, Outpatient Hospital, and 'Other' locations).

CONCLUSION

Among MS employees treated with DMTs in the real-world, 'A' and 'B' users had significantly greater reductions in SL costs post therapy initiation compared with 'C' and 'R'. Only 'A' users showed a significant reduction in SL absence days, while the other cohorts reported increases.

LIMITATIONS

Small sample sizes may limit the interpretability of these results.

Acid control cannot be improved with a modified-release formulation of a proton pump inhibitor compared with twice-daily dosing of the conventional formulation

AIM

The aim of this study was to compare acid control with a once-daily (od) modified-release (MR) formulation of esomeprazole vs. the conventional formulation (CF) dosed twice-daily (bid).

METHODS

In a randomized, five-way crossover study, 55 healthy volunteers underwent 24-h intragastric pH monitoring after 5-day treatment with MR esomeprazole (40, 60 or 80 mg od) and CF esomeprazole (20 or 40 mg bid).

RESULTS

Modified-release 60 and 80 mg od resulted in a significantly longer time with intragastric pH > 4 than MR 40 mg od (77.1 and 79.0% vs. 66.4%, respectively; both p < 0.05). At equivalent total daily doses, CF 20 mg bid led to a significantly longer time with intragastric pH > 4 than MR 40 mg od (72.3 vs. 66.4%; p < 0.05), and CF 40 mg bid led to a significantly longer time with pH > 4 than MR 80 mg od (85.5 vs. 79.0%; p < 0.05).

CONCLUSIONS

At equivalent total daily doses, the MR formulation of esomeprazole provides less 24-h acid control than the conventional formulation dosed twice-daily.

The impact of hepatitis C virus infection on work absence, productivity, and healthcare benefit costs

Chronic hepatitis C virus (HCV) infection is generally considered an asymptomatic disease. However, studies have shown that HCV has a substantial negative impact on patients' quality of life and functioning. This study was designed to compare absenteeism, productivity, and health cost between employees with and without HCV infection in the United States. Employee records from multiple large employers in the United States were obtained from the Human Capital Management Services Research Reference Database and were assessed for demographics, salary, healthcare use, work loss, and workers' compensation. HCV-infected subjects were identified by International Classification of Diseases 9th revision Clinical Modification codes. Controls were randomly selected from employees not diagnosed with HCV. T-tests and chi-square tests were used to determine if there were differences in demographic characteristics. Regression modeling compared days absent (among benefit-eligible employees) and productivity (among employees with data on task-oriented activities), while controlling for the impact of confounding factors. A total of 339,456 subjects were evaluated. Employees with HCV (n = 1664) had significantly more lost work days per employee than the control cohort (n = 337,792), including sick leave, short-term disability, and long-term disability. HCV-infected workers had 4.15 more days of absence per employee than the control cohort. Productivity was measured by units of work processed per hour; employees with HCV processed 7.5% fewer units per hour than employees without HCV (P > 0.05). All healthcare benefit costs among HCV employees were significantly higher than the same costs among employees without HCV. Overall, the total incremental difference was $8352 per year.

CONCLUSION

This real world study provides evidence that there is a substantial indirect burden of illness and describes a relationship between HCV infection, productivity, increased absenteeism, and higher healthcare benefit costs.

Impact of gastro-oesophageal reflux disease on work productivity despite therapy with proton pump inhibitors in Germany

BACKGROUND

Gastro-oesophageal reflux disease (GERD) is a common disorder with consequences for the patient's health-related quality of life (HRQoL). In Germany, few data are available on the impact of GERD on work-related productivity.

AIM

To study the impact of GERD on work productivity despite proton pump inhibitor (PPI) therapy and the association between productivity and symptom duration, severity, and HRQoL.

METHODS

Retrospective data from randomly selected patients with chronic GERD symptoms, treated by office-based general practitioners or general internists with routine clinical care, were analyzed together with information from self-administered instruments assessing work productivity (WPAI-GERD), symptoms (RDQ), and HRQoL (QOLRAD).

RESULTS

Reduced productivity was reported by 152 of 249 patients (61.0%), although 89.5% of them were treated with PPI. The reduction in work productivity was 18.5% in all patients and 30.3% in those with reduced productivity. Patients with impaired productivity showed a significantly lower HRQoL and more-severe symptoms of reflux disease. In all patients, the mean sick leave attributable to reflux symptoms was 0.6 hours in the previous seven days and 1.4 work days in the previous three months.

CONCLUSION

GERD has a substantial impact on work productivity in Germany, even in patients receiving routine clinical care and PPI therapy.

Functional dyspepsia impacts absenteeism and direct and indirect costs

BACKGROUND & AIMS

Functional dyspepsia (FD) is a common morbid condition but data are limited on the direct and indirect costs for employees with FD or on its impact on productivity. Few data on absenteeism and no objective information are available. This study aimed to assess the impact of FD on costs and effects on absenteeism and work output (productivity).

METHODS

We performed a retrospective analysis of payroll data and adjudicated health insurance medical and prescription claims collected over a 4-year study period (January 1, 2001 to December 31, 2004) from more than 300,000 employees. Data from employees with and without (controls) FD were compared using 2-part regression techniques. Outcome measures included medical (total and by place of service) and prescription costs, absenteeism, and objectively measured productivity output.

RESULTS

Employees with FD (N = 1669) had greater average annual medical and prescription drug costs and indirect costs (owing to sick leave and short- and long-term disability absences) than controls (N = 274,206). Compared with controls, the FD employees incurred costs that were $5138 greater and had greater costs for each place of service (all P < .0001). The employees with FD had an additional 0.83 absence days per year and produced 12% fewer units per hour than controls (both P < .05).

CONCLUSIONS

Employees with FD have greater costs at all places of service and lower productivity than employees without FD.

Stressful psychosocial factors and symptoms of gastroesophageal reflux disease: a population-based study in Norway

OBJECTIVE

Adverse psychosocial factors, including work-related stress, are, like gastroesophageal reflux disease (GERD), increasing health problems in industrialized countries. The importance of clarifying the relation between psychosocial factors and GERD has been stressed, but there are few population-based studies.

MATERIAL AND METHODS

This was a population-based, cross-sectional, case-control study based on two health surveys conducted in the Norwegian county Nord-Trondelag in 1984-86 and 1995-97. GERD symptoms were assessed in the second survey, which included 65,333 participants, representing 70% of the county's adult population. The 3153 persons reporting severe GERD symptoms were defined as cases and the 40,210 persons without such symptoms were defined as controls. Data on psychosocial factors and potential confounders were collected using questionnaires. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using unconditional logistic regression.

RESULTS

In models adjusted for age, sex, smoking, obesity and socioeconomic status, positive associations were observed between high job demands (OR 1.9, 95% CI 1.6-2.2), low job control (OR 1.1, 95% CI 1.0-1.2) and job strain (OR 1.9, 95% CI 1.6-2.4) and risk of GERD symptoms. Persons reporting low job satisfaction had a twofold (95% CI 1.6-2.5) increased risk of GERD compared to persons reporting high job satisfaction. Self pressure (OR 1.8, 95% CI 1.6-2.1) and time pressure (OR 2.0, 95% CI 1.7-2.4) were positively associated with GERD symptoms. These associations were attenuated after further adjustment for anxiety, depression, myocardial infarction, angina pectoris, stroke and insomnia, but remained statistically significant.

CONCLUSIONS

This population-based study reveals a link between stressful psychosocial factors, including job strain, and GERD symptoms.

Burden of fibromyalgia and comparisons with osteoarthritis in the workforce

OBJECTIVES

To calculate the fibromyalgia (FM) burden of illness (BOI) from the employer perspective and to compare annual prevalence, work output, absence, and health benefit costs of employees with FM versus osteoarthritis (OA).

METHODS

Retrospective regression model analysis comparing objective work output, total health benefit (health care, prescription drug, sick leave, disability, workers' compensation) costs, and absence days for FM, versus OA and NoFM cohorts, while controlling for differences in patient characteristics.

RESULTS

FM prevalence was 0.73%; OA 0.90%. Total health benefit costs for FM were $8452 versus $11,253 (P < 0.0001) for OA and $4013 (P < 0.0001) for NoFM, with BOI = $4439. Total absence days were 16.8 versus 19.8 (P < 0.0001) and 6.4 (P < 0.0001), respectively. FM had significantly lower annual work output than NoFM (19.5%, P = 0.003) but comparable with OA.

CONCLUSION

FM places a significant cost, absence, and productivity burden on employers.

Impact of gastroesophageal reflux disease on work absenteeism, presenteeism and productivity in daily life: a European observational study

Background

The RANGE (Retrospective ANalysis of GastroEsophageal reflux disease [GERD]) study assessed differences among patients consulting a primary care physician due to GERD-related reasons in terms of: symptoms, diagnosis and management, response to treatment, and effects on productivity, costs and health-related quality of life. This subanalysis of RANGE determined the impact of GERD on productivity in work and daily life.

Methods

RANGE was conducted at 134 primary care sites across six European countries (Germany, Greece, Norway, Spain, Sweden and the UK). All subjects (aged ≥18 years) who consulted with their primary care physician over a 4-month identification period were screened retrospectively, and those consulting at least once for GERD-related reasons were identified (index visit). From this population, a random sample was selected to enter the study and attended a follow-up appointment, during which the impact of GERD on productivity while working (absenteeism and presenteeism) and in daily life was evaluated using the self-reported Work Productivity and Activity Impairment Questionnaire for patients with GERD (WPAI-GERD).

Results

Overall, 373,610 subjects consulted with their primary care physician over the 4-month identification period, 12,815 for GERD-related reasons (3.4%); 2678 randomly selected patients attended the follow-up appointment. Average absenteeism due to GERD was highest in Germany (3.2 hours/week) and lowest in the UK (0.4 hours/week), with an average of up to 6.7 additional hours/week lost due to presenteeism in Norway. The average monetary impact of GERD-related work absenteeism and presenteeism were substantial in all countries (from €55/week per employed patient in the UK to €273/patient in Sweden). Reductions in productivity in daily life of up to 26% were observed across the European countries.

Conclusion

GERD places a significant burden on primary care patients, in terms of work absenteeism and presenteeism and in daily life. The resulting costs to the local economy may be substantial. Improved management of GERD could be expected to lessen the impact of GERD on productivity and reduce costs.

Factors Associated with Incidental Sickness Absence among Employees in One Health Care System

Purpose.

Assess the association of taking incidental sickness absence with health risks and health status.

Design.

Observational.

Setting.

One Midwest health care system.

Subjects.

Individuals who were employed for 2 years (2006–2007) and had completed at least one health risk appraisal (HRA) in 2007 (N = 3790).

Measures.

Outcomes were any incidental sickness absence and absence duration in 2007 measured by an absence tracking system. Health risks and health status were estimated by HRAs. Program participation was captured using 7-year HRA data and 5-year wellness data.

Analysis.

Multivariate, binary logistic regression for the probability of taking any absence day among the overall population as well as four demographic subgroups; proportional odds model for the probability of taking more absence days.

Results.

Different patterns were observed in association with taking incidental sickness absence among age and gender subgroups. Among the overall population, three health risks (smoking overweight, and use of medication for relaxation) were positively associated with taking absence (at least p <. 05 for all three health risks). Participation in a wellness program for more years was also associated with a less likelihood of taking absence (odds ratio, .72; p = .002). Results from the proportional odds model were consistent with results from the binary logistic regression.

Conclusion.

Sickness absence is an important productivity concern of employers. Employers may implement early interventions to focus on preventable causes. Special interventions may target absence-causing risks such as smoking behavior and excess body weight. Study limitation includes a lack of measures for psychosocial work environment.

Absenteeism and health-benefit costs among employees with MS

OBJECTIVE

The purpose of this analysis was to assess the differences in lost time and health-benefit costs (HBCs) among employees treated with disease modifying treatments (DMTs) for multiple sclerosis (MS).

STUDY DESIGN

Employees with an MS diagnostic code (ICD-9 340.xx) and a DMT prescription claim (1/1/2001-6/30/2007) were identified from the HCMS Research Reference Database and assigned to DMT cohorts. The first prescription for the DMT was used as each person's index date. One-year outcomes included HBCs and absenteeism (lost time, comprising sick leave [SL], short- and long-term disability [STD/LTD], and workers' compensation).

METHODS

Demographics were compared using t-tests for continuous variables and chi-square tests for discrete variables. Two-part multivariate regression modeling (logistic regression combined with generalized linear regression) was used to determine annual HBCs and absenteeism for each cohort controlling for age, gender, job-related variables, and Charlson Comorbidity Score. All cost variables were inflated to US$2007.

RESULTS

Annual ranges among the DMTs were: HBCs $17,953-26,970 and absenteeism 7.33-20.67 days. Compared with glatiramer acetate ('C'), IFN-beta1a IM ('A') users had lower SL ($445, p = 0.0469) and STD ($969, p = 0.0164) costs; and IFN-beta1b ('B') users had lower medical costs ($2143, p = 0.0091). In addition, those treated with 'A' had 4.2 fewer SL days (p = 0.0101) compared with those treated with 'C'.

CONCLUSIONS

Patients treated with 'A' reported significantly lower SL costs, SL days, and STD costs than patients treated with 'C', suggestive of greater real world benefits with 'A'. Despite small sample sizes and the retrospective nature, the study provides interesting insights into the use of DMTs in MS. The study also revealed important areas of future research, specifically the need for development of methods to determine which MS patient groups respond best to which DMT treatments.

Patient factors predictive of 24-h pH normalization following endoluminal gastroplication for GERD

BACKGROUND

Endoluminal full-thickness gastroplication has been documented to provide significant and long-lasting improvement of GERD symptoms and health-related quality of life (HRQL) with very little patient morbidity. These treatments, however, are criticized for normalizing esophageal acid exposure in only 30-40% of patients treated. We hypothesize that there are objective criteria that will identify those patients who will have a normal DeMeester score (DMS) following endoluminal treatment.

METHODS

Data from a prospective multicenter trial using the NDO Plicator device to treat GERD were available for statistical analysis. All patients were treated with endoluminal full-thickness gastroplication. All patients had GERD symptoms and abnormal 24-h pH exposure preoperatively. Postoperative objective outcome was assessed by performing 24-h pH studies at 6 months. Univariate and multivariate regression analyses were performed to determine factors predictive of successful treatment (normalized 24-h pH).

RESULTS

A total of 266 patients were included in the study. Mean preoperative DMS was 47.91 (+/-31.34). Postoperatively, mean DMS decreased significantly (37.11 +/- 24.63, p < 0.001), and 31.67% of patients had a DMS within normal range (DMS < 22). Results of multivariate regression analysis demonstrated that the following preoperative patient characteristics were predictive of postoperative success (normal DMS): DMS < 30 (odds ratio [OR] = 4.24, 95% confidence interval [CI] = 1.73, 10.36, p < 0.001), heartburn score < 2 (OR = 3.37, CI = 1.44, 7.89, p = 0.005), and BMI < 30 (OR = 4.93, CI = 1.55, 15.61, p = 0.007).

CONCLUSION

Data analysis from this prospective study indicates that the odds of objective success would be significantly greater if the treatment was restricted to thinner patients with mild reflux disease. This may help define the optimal place for endoluminal therapy in a comprehensive GERD treatment algorithm.