Zand Aria, van Deen Welmoed K, Inserra Elizabeth K, Hall Laurin, Kane Ellen, Centeno Adriana, Choi Jennifer M, Ha Christina Y, Esrailian Eric, DʼHaens Geert R, Hommes Daniel W
*UCLA Center for Inflammatory Bowel Diseases, Melvin and Bren Simon Digestive Diseases Center, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and †Center for Inflammatory Bowel Diseases, Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
Inflamm Bowel Dis. 2015 Jul;21(7):1623-30. doi: 10.1097/MIB.0000000000000399.
Indirect costs associated with impaired productivity at work (presenteeism) due to inflammatory bowel disease (IBD) are a major contributor to health expenditures. Studies estimating indirect costs in the United States did not take presenteeism into account. We aimed to quantify work limitations and presenteeism and its associated costs in an IBD population to generate recommendations to reduce presenteeism and decrease indirect costs.
We performed a prospective study at a tertiary IBD center. During clinic visits, work productivity, work-related problems and adjustments, quality of life, and disease activity were assessed in patients with IBD. Work productivity and impairment were assessed in a control population as well. Indirect costs associated with lost work hours (absenteeism) and presenteeism were estimated, as well as the effect of disease activity on those costs.
Of the 440 included patients with IBD, 35.6% were unemployed. Significantly more presenteeism was detected in patients with IBD (62.9%) compared with controls (27.3%) (P = 0.004), with no significant differences in absenteeism. Patients in remission experienced significantly more presenteeism than controls (54.7% versus 27.3%, respectively, P < 0.01), and indirect costs were significantly higher for remissive patients versus controls ($17,766 per yr versus $9179 per yr, respectively, P < 0.03). Only 34.3% had made adjustments to battle work-related problems such as fatigue, irritability, and decreased motivation.
Patients with IBD in clinical remission still cope with significantly more presenteeism and work limitations than controls; this translates in higher indirect costs and decreased quality of life. The majority have not made any adjustments to battle these problems.
炎症性肠病（IBD）导致的工作效率受损（出勤主义）相关的间接成本是医疗支出的主要组成部分。在美国，估计间接成本的研究未将出勤主义考虑在内。我们旨在量化IBD患者群体中的工作限制和出勤主义及其相关成本，以提出减少出勤主义和降低间接成本的建议。
我们在一家三级IBD中心进行了一项前瞻性研究。在门诊就诊期间，对IBD患者的工作效率、与工作相关的问题及调整、生活质量和疾病活动情况进行了评估。同时也对对照组人群的工作效率和损伤情况进行了评估。估计了与工作时间损失（旷工）和出勤主义相关的间接成本，以及疾病活动对这些成本的影响。
在纳入研究的440例IBD患者中，35.6%处于失业状态。与对照组（27.3%）相比，IBD患者中检测到的出勤主义显著更多（62.9%）（P = 0.004），旷工方面无显著差异。缓解期患者的出勤主义明显多于对照组（分别为54.7%和27.3%，P < 0.01），缓解期患者的间接成本显著高于对照组（分别为每年17,766美元和每年9179美元，P < 0.03）。只有34.3%的患者针对疲劳、易怒和动力下降等与工作相关的问题进行了调整。
临床缓解期的IBD患者仍然比对照组应对更多的出勤主义和工作限制；这导致更高的间接成本和生活质量下降。大多数患者尚未针对这些问题进行任何调整。
