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Abstract
Objective
Productivity loss was compared by 3-stage of disease activity and associations between higher disease activity and high productivity loss were identified.
Methods
Data were extracted from Rheumatoid Arthritis (RA) Patient-reported Outcomes Research, which enrolled 2,000 RA patients (＞20-year) on disease-modifying-antirheumatic-drugs (DMARDs) (≥6-month) from December 2012 to June 2013. This included 1,457 RA patients with the disease activity score (DAS-28-ESR) in their medical charts. Productivity loss in time and indirect cost was estimated using The World Health Organization Health and Work Performance Questionnaire (HPQ). Baseline characteristics and productivity loss outcomes were compared according to DAS-28-ESR groups.
Results
84.4% were females, 54.2% had low DAS-28-ESR (＜3.2), and 38.2% and 7.6% had moderate (3.2∼5.1) and high DAS-28-ESR (＞5.1). Patients with moderate to high DAS-28-ESR had higher lost productivity time (LPT) and monthly costs of LPT than those with low DAS-28-ESR (time in hours: 110.0±58.4 vs. 132.4±57.2 vs. 71.5±52.0, p＜0.0001; monthly costs of LPT in 1,000 Korean won: 1,097±607 vs. 1,302±554 vs. 741±531, p＜0.0001). Multiple regression analyses revealed significant associations with high LPT in high (adjusted odds ratio [OR]=3.87, 95% confidence interval [CI]: 2.18∼6.87) and moderate DAS-28-ESR (adjusted OR=1.88, 95% CI: 1.41∼2.52) compared to low DAS-28-ESR. In addition, positive associations with high monthly costs of LPT were observed in high (adjusted OR=3.45, 95% CI: 1.98∼5.99) and moderate DAS-28-ESR (adjusted OR=1.93, 95% CI: 1.43∼2.54) compared to low DAS-28-ESR.
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Figure 1.
Lost productivity time in hours by DAS-28-ESR in the past one month. DAS-28-ESR: disease activity score-28-ery-throcyte sedimentation rate. *p-value by analysis of variance.
Figure 2.
Productivity loss in indirect cost by DAS-28-ESR per month. DAS-28-ESR: disease activity score-28-erythrocyte sedimentation rate. *p-value by analysis of variance.
Table 1.
Patient characteristics by disease activity score (DAS-28-ESR)
| Variable | Total (n=1,457) | DAS-28-ESR ＜3.2(n=790, 54.2%) | DAS-28-ESR 3.2∼5.1(n=557, 38.2%) | DAS-28-ESR ＞5.1(n=110, 7.6%) | p-value* |
|---|---|---|---|---|---|
| Gender | 0.0003 | ||||
| Male | 227 (15.6) | 151 (19.1) | 62 (11.1) | 14 (12.7) | |
| Female | 1,230 (84.4) | 639 (80.9) | 495 (88.9) | 96 (87.3) | |
| Age (yr) | 0.0092 | ||||
| N | 1,457 | 790 | 557 | 110 | |
| Mean±SD | 55.7±11.9 | 54.8±11.7† | 56.7±11.9† | 56.7±12.5 | |
| Median | 55.0 | 55.0 | 57.0 | 57.0 | |
| Min, max | 20, 87 | 20, 87 | 25, 86 | 20, 80 | |
| Duration of disease | e (yr) | 0.0003 | |||
| N | 1,358 | 746 | 516 | 96 | |
| Mean±SD | 8.4±7.1 | 7.8±6.8† | 9.2±7.5† | 9.9±7.5† | |
| Median | 6.4 | 5.5 | 7.5 | 8.3 | |
| Min, max | 0, 44 | 0.0, 44.4 | 0.3, 44.5 | 0.0, 30.7 | |
| RF positivity | 0.0479 | ||||
| Positive | 1,124 (77.1) | 591 (74.8) | 440 (79.0) | 93 (84.6) | |
| Negative | 307 (21.1) | 187 (23.7) | 104 (18.7) | 16 (14.6) | |
| Unknown | 26 (1.8) | 12 (1.5) | 13 (2.3) | 1 (0.9) | |
| Anti-CCP positivity | 0.0636 | ||||
| Positive | 1,016 (69.7) | 545 (69.0) | 393 (70.6) | 78 (70.9) | |
| Negative | 209 (14.3) | 129 (16.3) | 71 (12.7) | 9 (8.2) | |
| Unknown | 232 (15.9) | 116 (14.7) | 93 (16.7) | 23 (20.9) | |
| CCI | 0.3671 | ||||
| 1∼2 | 1,311 (90.0) | 720 (91.1) | 493 (88.5) | 98 (89.1) | |
| 3∼4 | 126 (8.6) | 62 (7.9) | 55 (9.9) | 9 (8.2) | |
| ≥5 | 20 (1.4) | 8 (1.0) | 9 (1.6) | 3 (2.7) | |
| Current steroid use | ＜0.0001 | ||||
| Yes | 1,042 (71.5) | 516 (65.3) | 434 (77.9) | 92 (83.6) | |
| No | 415 (28.5) | 274 (34.7) | 123 (22.1) | 18 (16.4) | |
| Current NSAID use Yes | e 1,099 (75.4) | 578 (73.2) | 428 (76.8) | 93 (84.6) | 0.0211 |
| No | 358 (24.6) | 212 (26.8) | 129 (23.2) | 17 (15.5) | |
| KHAQ score | ＜0.0001 | ||||
| Mean±SD | 0.7±0.7 | 0.4±0.5† | 0.9±0.7† | 1.3±0.8† | |
| Median | 0.5 | 0.3 | 0.9 | 1.1 | |
| Min, max | 0, 3 | 0, 3 | 0, 3 | 0, 3 |
Values are presented number (%) otherwise indicated. DAS-28-ESR: disease activity score-28-erythrocyte sedimentation rate, SD: standard deviation, RF: rheumatoid factor, CCP: cyclic citrullinated peptide, CCI: Charlson comorbidity index, Connective tissue disease was considered for all rheumatoid arthritis patients, NSAID: nonsteroidal anti-inflammatory drug, HAQ: health assessment questionnaire.
Table 2.
Productivity loss in rheumatoid arthritis over past four weeks
| Variable | Total (n=1,457) | DAS-28-ESR ＜3.2(n=790, 54.2%) | DAS-28-ESR 3.2∼5.1(n=557, 38.2%) | DAS-28-ESR ＞5.1(n=110, 7.6%) | p-value* |
|---|---|---|---|---|---|
| Absenteeism | |||||
| Actual days worked if not sick due to RA (d) | 0.4202 | ||||
| Mean±SD | 26.0±3.8 | 25.9±3.7 | 26.1±3.8 | 25.7±4.7 | |
| Median | 28.0 | 28.0 | 28.0 | 28.0 | |
| Min, max | 5, 28 | 8, 28 | 5, 28 | 8, 28 | |
| Entire work days missed due to RA (d) | ＜0.0001 | ||||
| Mean±SD | 1.7±5.0 | 0.7±3.2† | 2.5±5.9† | 4.3±7.7† | |
| Median | 0.0 | 0.0 | 0.0 | 0.0 | |
| Min, max | 0, 28 | 0, 28 | 0, 28 | 0, 28 | |
| Partial days missed due to RA (d) | ＜0.0001 | ||||
| Mean±SD | 3.0±6.5 | 1.7±4.8† | 4.3±7.4† | 6.4±8.7† | |
| Median | 0.0 | 0.0 | 0.0 | 1.8 | |
| Min, max | 0, 28 | 0, 28 | 0, 28 | 0, 28 | |
| Lost productivity time in hours | ＜0.0001 | ||||
| Mean±SD | 90.9±59.0 | 71.5±52.0† | 110.0±58.4† | 132.4±57.2† | |
| Median | 85.6 | 67.0 | 112.0 | 128.0 | |
| Min, max | 0, 224 | 0, 224 | 0, 224 | 0, 224 | |
| Presenteeism | |||||
| Performance of most workers in a similar job‡ | 0.0629 | ||||
| Mean±SD | 7.8±1.9 | 7.9±1.8 | 7.7±1.9 | 7.5±2.0 | |
| Median | 8.0 | 8.0 | 8.0 | 8.0 | |
| Min, max | 0, 10 | 0, 10 | 0, 10 | 0, 10 | |
| Overall performance‡ | ＜0.0001 | ||||
| Mean±SD | 6.1±2.4 | 6.9±2.1† | 5.4±2.3† | 4.4±2.4† | |
| Median | 5.0 | 7.0 | 5.0 | 5.0 | |
| Min, max | 0, 10 | 0, 10 | 0, 10 | 0, 10 | |
| Overall performance compared to others§ | ＜0.0001 | ||||
| Mean±SD | 4.7±1.6 | 4.3±1.5† | 5.1±1.5† | 5.6±1.5† | |
| Median | 4.0 | 4.0 | 5.0 | 6.0 | |
| Min, max | 1, 7 | 1, 7 | 1, 7 | 2, 7 | |
| Monthly cost of lost productivity time (1,000 Korean won) | ＜0.0001 | ||||
| Mean±SD | 920±597 | 741±531† | 1,097±607† | 1,302±554† | |
| Median | 858 | 673 | 994 | 1,369 | |
| Min, max | 0, 3,626 | 0, 3,626 | 0, 3,506 | 0, 2,671 | |
Table 3.
Univariate and multivariate analysis of factors associated with high lost productivity time (≥100 hours)
OR: odds ratio, CI: confidence interval, DAS-28-ESR: disease activity score-28-erythrocyte sedimentation rate, RF: rheumatoid factor, CCP: cyclic citrullinated peptide, CCI: Charlson comorbidity index, Connective tissue disease was considered for all rheumatoid arthritis patients, NSAID: nonsteroidal anti-inflammatory drug, HAQ: health assessment questionnaire.
Table 4.
Univariate and multivariate analysis of factors associated with high monthly cost of lost productivity time (≥1,000,000 Korean won)
OR: odds ratio, CI: confidence interval, DAS-28-ESR: disease activity score-28-erythrocyte sedimentation rate, RF: rheumatoid factor, CCP: cyclic citrullinated peptide, CCI: Charlson comorbidity index, Connective tissue disease was considered for all rheumatoid arthritis patients, NSAID: nonsteroidal anti-inflammatory drug, HAQ: health assessment questionnaire.
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