Binion David G, Louis Edouard, Oldenburg Bas, Mulani Parvez, Bensimon Arielle G, Yang Mei, Chao Jingdong
Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh, Pennsylvania 15213, USA. binionpitt.edu
Can J Gastroenterol. 2011 Sep;25(9):492-6. doi: 10.1155/2011/938194.
To assess the effect of adalimumab on work productivity and indirect costs in patients with Crohn's disease (CD) using a meta-analysis of clinical trials.
Study-level results were pooled from all clinical trials of adalimumab for moderate to severe CD in which work productivity outcomes were evaluated. Work Productivity and Activity Impairment Questionnaire outcomes (absenteeism, presenteeism and total work productivity impairment [TWPI]) were extracted from adalimumab trials. Meta-analyses were used to estimate pooled averages and 95% CIs of one-year accumulated reductions in work productivity impairment with adalimumab. Pooled averages were multiplied by the 2008 United States national average annual salary ($44,101) to estimate per-patient indirect cost savings during the year following adalimumab initiation.
The four included trials (ACCESS, CARE, CHOICE and EXTEND) represented a total of 1202 employed adalimumab-treated patients at baseline. Each study followed patients for a minimum of 20 weeks. Pooled estimates (95% CIs) of one-year accumulated work productivity improvements were as follows: -9% (-10% to -7%) for absenteeism; -22% (-26% to -18%) for presenteeism; and -25% (-30% to -20%) for TWPI. Reductions in absenteeism and TWPI translated into per-patient indirect cost savings (95% CI) of $3,856 ($3,183 to $4,529) and $10,964 ($8,833 to $13,096), respectively.
Adalimumab provided clinically meaningful improvements in work productivity among patients with moderate to severe CD, which may translate into substantial indirect cost savings from an employer's perspective.
通过对临床试验的荟萃分析，评估阿达木单抗对克罗恩病（CD）患者工作效率及间接成本的影响。
汇总所有评估阿达木单抗治疗中度至重度CD工作效率结果的临床试验的研究水平结果。从阿达木单抗试验中提取工作效率与活动障碍问卷结果（缺勤率、出勤但工作效率低下及总体工作效率受损[TWPI]）。采用荟萃分析来估计阿达木单抗治疗一年累积工作效率受损降低值的合并平均值及95%置信区间。将合并平均值乘以2008年美国全国平均年薪（44,101美元），以估计阿达木单抗开始使用后一年内每位患者的间接成本节省情况。
纳入的四项试验（ACCESS、CARE、CHOICE和EXTEND）在基线时共有1202名使用阿达木单抗治疗的在职患者。每项研究对患者随访至少20周。一年累积工作效率改善的合并估计值（95%置信区间）如下：缺勤率为-9%（-10%至-7%）；出勤但工作效率低下为-22%（-26%至-18%）；TWPI为-25%（-30%至-20%）。缺勤率和TWPI的降低分别转化为每位患者间接成本节省（95%置信区间）3856美元（3183美元至4529美元）和10964美元（8833美元至13096美元）。
阿达木单抗在中度至重度CD患者的工作效率方面提供了具有临床意义的改善，从雇主角度看，这可能转化为大量间接成本节省。
