Impact of COVID-19 on work loss in the United States- A retrospective database analysis.

OBJECTIVES: This study investigates the utilization of work absence benefits among United States (US) employees diagnosed with COVID-19, examining frequency, duration, cost, and types of work loss benefits used. METHODS: This retrospective analysis of the Workpartners Research Reference Database (RRDb) included employees eligible for short- and long-term disability (STD and LTD employer-sponsored benefits, respectively), and other paid work absence benefits from 2018 to 2022. Workpartners RRDb includes over 3.5 million employees from over 500 self-insured employers across the US. Employees were identified by codes from adjudicated medical and disability claims for COVID-19 (2020-2022) and influenza, as well as prescription claims for COVID-19 treatments. Associated payments were quantified for each absence reason. RESULTS: Approximately 1 million employees were eligible for employer-sponsored paid leave benefits between January 2018 and December 2022. The mean age was 37 years (22% >50 years), and 49.4% were females. COVID-19 was the 2nd most common reason for an STD claim (6.9% of all STD claims) and 13th for an LTD claim (1.7% of all LTD claims) from 2020-2022. The mean duration for COVID-19 STD claims was 24 days (N = 3,731, mean claim=$3,477) versus 10 days for influenza (N = 283, mean claim=$1,721). The mean duration for an LTD claim for COVID-19 was 153 days (N = 11, mean claim=$19,254). Only 21.5% of employees with STD claims in the COVID-19 cohort had prior COVID-19-associated medical or pharmacy claims; over half (range 53%-61%) had documented high risk factors for severe COVID-19. CONCLUSION: COVID-19 and influenza have the potential to cause work loss in otherwise healthy employees. In this analysis, COVID-19 was the second most frequent reason for an STD claim at the start of the pandemic and remained high (ranked 5th) in 2022. These results highlight the impact of COVID-19 on work loss beyond the acute phase. Comprehensively evaluating work loss implications may help employers prioritize strategies, such as vaccinations and timely treatments, to mitigate the impact of COVID-19 on employees and their companies.

COVID-19 results in short- and long-term symptoms that may affect employees' ability to work. Short- and long-term disability (STD and LTD, respectively), other work absences, and medical and pharmacy claims from the Workpartners Research Reference Database were analyzed for US adult (≥18 years) employees. COVID-19 claims were identified using the Center for Disease Control and Prevention recommended International Classification of Diseases codes during the analysis from 2020 to 2022. During 2020 to 2022, COVID-19 ranked as the second most frequent reason for STD claims and 13th most frequent among LTD claims. Influenza ranked 58th overall with no LTD claims (2018­2022). The average COVID-19 STD claim lasted 24 days and cost employers $3,477 per claim, and LTD claims averaged 153 days, costing $19,254. Only 21.5% of employees with STD claims in the COVID-19 cohort had prior COVID-19-associated medical or pharmacy claims, and over half (range 53%­61%) had a documented high-risk factor for severe COVID-19. Our results highlight the ongoing and substantial impact of COVID-19 on work absence benefit utilization beyond the acute phase. This analysis demonstrates the need for employers and researchers to review all available medical, pharmacy, and disability claims to assess the acute and long-term impact of COVID-19 on employees and prioritize mitigation strategies to reduce the burden of the virus to their employees.

Disability and workers' compensation trends for employees with mental disorders and SUDs in the United States.

INTRODUCTION: US employee absence benefits may include workers' compensation (WC) for work-related injuries/illnesses, short- and long-term disability (STD and LTD, respectively) for non-work-related injuries/illnesses, and discretionary sick leave (SL). Absences can significantly impact business performance, and employers are intensifying efforts to manage benefits and connections with employee health. This research compares all-cause STD/LTD/WC/SL use and variation from baseline (2002) for eligible employees (EMPs) with mental disorders (MDs) and SUDs to determine if use/payments varied over time. METHODS: Employees incurring medical claims with Agency for Healthcare Research and Quality MD and SUD ICD-9/10 codes were identified in the WorkPartners database (January 1, 2002 to December 31, 2019). Retrospective analysis was performed on annual prevalence, benefit use, mean days of leave, and median payments as a percent of salary (including lump-sum distributions and potentially extending beyond initiation year). WC claims without work absences were excluded. For each benefit, annual outcomes were calculated as a percent of baseline to show variability. RESULTS: Use was 48.1% to 202.2% (median, 102.8%) of baseline rates for SL (SUD-EMPs), and 87.3% to 108.4% (median, 97.3%) for STD (MD-EMPs). Days of LTD leaves were 21.5% to 657.8% (median, 359.2%) of baseline days (MD-EMPs), and 122.7% to 1042.2% (median, 460.0%) of baseline days for (SUD-EMPs). Median payments for WC were 78.6% to 253.6% (median, 114.6%) of baseline (MD-EMPs) and 97.9% to 481.6% (median, 104.0%) for SUD-EMPs. DISCUSSION: Employees with MD/SUD used absence benefits at differing rates over time with varying days of leave and payments as a percent of salary. Using a constant cost or salary replacement factor over time for all benefits is not accurate or appropriate.

Direct and Indirect Costs Among Caregivers of Patients With Major Depressive Disorder and Suicidal Ideation or Suicidal Attempt.

Objective: To compare direct and indirect costs among caregivers of patients with major depressive disorder (MDD) and suicidal ideation and/or suicide attempts (MDSI) versus caregivers of patients with MDD alone versus caregivers of patients without MDD or suicidal ideation and/or suicide attempts (controls).Methods: Cohorts were based on caregivers of adult patients with MDSI, MDD alone, and controls. Patients were identified by Workpartners employer database ICD-9/ICD-10 codes (January 2010 to July 2019) and were spouses or domestic partners of employees (caregivers). Twenty controls and 20 MDD-alone caregivers were matched to each MDSI caregiver on sex, age, and index year. All caregiver-patient pairs had 6 months pre/postindex information and met additional inclusion/exclusion criteria. Patient and caregiver medical and prescription claims and caregiver absenteeism (payment/time) were analyzed. Direct costs (medical, prescription) and indirect costs (absence payments by benefit type) were analyzed using separate, 2-part stepwise regression models and controlling for demographics, job-related variables, region, index year, and Charlson Comorbidity Index score.Results: 570 MDSI caregiver-patient pairs and 11,400 matched MDD-alone and control pairs were identified. MDSI and MDD-alone caregivers had higher medical costs compared with controls ($5,131 and $4,548 versus $3,885, respectively; P < .0001). Prescription costs were highest among MDSI caregivers, followed by MDD-alone and control caregivers ($1,852, $1,425, and $1,005, respectively; P < .001). MDSI caregivers had the highest total indirect costs. MDSI patient medical and prescription costs were highest, followed by MDD-alone and control patients.Conclusion: MDSI caregivers had significantly greater direct and indirect costs compared with MDD-alone and non-MDD caregivers.

Burden of acromegaly in the United States: increased health services utilization, location of care, and costs of care.

BACKGROUND: Limited information is available on the utilization and healthcare costs among patients with acromegaly. The purpose of this study was to assess the impact of acromegaly on healthcare utilization and costs by locations of care (LoC). METHODS: Patients with acromegaly and controls were identified from an analysis of drug and medical claims filed from January 2010 to April 2019 from a US employer database. Each patient with acromegaly was matched with 20 random controls (without acromegaly) selected from the database. Claims were tracked for 12 months postdiagnosis (or matched date for controls). Outcomes by LoC, including costs, services, and likelihood of use, were compared using two-stage regression models or logistic regression models, controlling for demographic and job-related variables, and Charlson comorbidity index scores. RESULTS: Claims from 60 patients with acromegaly and 1,200 controls were analyzed. Compared with the control group, patients with acromegaly had significantly higher likelihoods of receiving care in a physician's office [odds ratio > 1,000], inpatient [OR = 8.010], outpatient [OR = 12.656], laboratory [OR = 3.681], and 'other' locations [OR = 4.033] (all p < .001), except in an emergency department (ED). Significantly more services were performed at each LoC for those with acromegaly (p < .01) but not in an ED. Total costs were more than 5-fold higher for the acromegaly cohort compared with controls (p < .05). Costs by LoC were consistently higher (p < .001) for patients with acromegaly vs. controls, with mean annual cost differences greatest in outpatient hospital/clinic ($9,611 vs $1,355), inpatient ($8,646 vs $739), physicians' office ($4,762 vs $1,301), other ($2,001 vs $367), and laboratory ($508 vs $66). ED-related treatment costs were not significantly different between cohorts. CONCLUSIONS: Compared with matched controls, patients with acromegaly were more likely to utilize healthcare services in nearly all LoCs and accrue higher expenditures at each LoC, with the exception of ED services.

Costs and absence of HCV-infected employees by disease stage.

OBJECTIVES: Quantify the costs and absenteeism associated with stages of the Hepatitis C virus (HCV). STUDY DESIGN: Retrospective analysis of the HCMS integrated database from multiple geographically diverse, US-based employers with employee information on medical, prescription, and absenteeism claims. METHODS: Employee data were extracted from July 2001-March 2013. Employees with HCV were identified by ICD-9-CM codes and classified into disease severity cohorts using diagnosis/procedure codes assigning the first date of most severe claim as the index date. Non-HCV employees (controls) were assigned random index dates. Inclusion required 6-month pre-/post-index eligibility. Medical, prescription, and absenteeism cost and time were analyzed using two-part regression (logistic/generalized linear) models, controlling for potentially confounding factors. Costs were inflation adjusted to September 2013. RESULTS: All direct costs comparisons were statistically significant (p ≤ 0.05) with mean medical costs of $1813 [SE = $3] for controls (n = 727,588), $4611 [SE = $211] for non-cirrhotic (n = 1007), $4646 [SE = $721] for compensated cirrhosis (CC, n = 87), $12,384 [SE = $1122] for decompensated cirrhosis (DCC, n = 256), $33,494 [SE = $11,753] for hepatocellular carcinoma (HCC, n = 17) and $97,724 [SE = $32,437] for liver transplant (LT, n = 19) cohorts. Mean short-term disability days/costs were significantly greater for the non-cirrhotic (days = 2.03 [SE = 0.36]; $299 [SE = $53]), DCC (days = 6.20 [SE = 1.36]; $763 [SE = $169]), and LT cohorts (days = 21.98 [SE = 8.21]; $2537 [SE = $972]) compared to controls (days = 1.19 [SE = 0.01]; $155 [SE = $1]). Mean sick leave costs were significantly greater for non-cirrhotic ($373 [SE = $22]) and DCC ($460 [SE = $54]) compared to controls ($327 [SE = $1]). CONCLUSIONS: Employees with HCV were shown to have greater direct and indirect costs compared to non-HCV employee controls. Costs progressively increased in the more severe HCV disease categories. Slowing or preventing disease progression may avert the costs of more severe liver disease stages and enable employees with HCV to continue as productive members of the workforce.

United States comparative costs and absenteeism of diabetic ophthalmic conditions.

OBJECTIVE: This retrospective cohort study examined the impact of diabetic macular edema (DME), diabetic retinopathy (DR), or diabetes on annual health benefit costs and absenteeism in US employees. METHODS: Claims data from 2001 to 2012 was extracted from the Human Capital Management Services Group Research Reference Database on annual direct/indirect health benefit costs and absences for employees aged ≥ 18 years. Employees with DME, DR, or diabetes were identified by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Employees were divided into two groups, drivers or nondrivers, and examined in separate analyses. For drivers and nondrivers, the DME, DR, and diabetes cohorts were compared with their respective control groups (without diabetes). Two-part regression models controlled for demographics and job-related characteristics. RESULTS: A total of 39,702 driver and 426,549 nondriver employees were identified as having ≥ 1 year's continuous health plan enrollment. Direct medical costs for drivers with DME, DR, or diabetes were $6470, $8021, and $5102, respectively (>2.8 times higher and statistically significant compared with driver controls). Nondrivers with DME and DR incurred significantly higher sick leave and short-term disability costs compared with the nondrivers with diabetes and nondriver controls. In drivers with DME, the majority of days of absence were for short- and long-term disability (12.41 and 11.43 days, respectively). In drivers with DR, the majority of days of absence were for short-term disability (10.70 days). In nondrivers with DME and nondrivers with DR, the majority of days of absence were for sick leave (5.74 and 4.93 days, respectively) and short-term disability (5.08 and 4.93 days, respectively). CONCLUSION: DME and DR are associated with substantial direct medical cost and absenteeism in this real-world sample of medically insured employees. This research highlights the negative impact of DME and DR on annual costs and absenteeism and may assist employers in assessing the impact of these conditions on employees.

Persistence and adherence with urinary antispasmodic medications among employees and the impact of adherence on costs and absenteeism.

BACKGROUND: Overactive bladder (OAB) and related conditions, such as urge urinary incontinence (UI), can interfere with work, leisure activities, and healthy sleep patterns. OBJECTIVES: To report (a) employee urinary antispasmodic (UA) medication persistence and adherence; (b) the impact of salary and copay on adherence; and (c) the impact of UA adherence on medical, pharmacy, sick leave (SL), short- and long-term disability (STD, LTD), workers' compensation costs, work absence days, and turnover. METHODS: This retrospective study used a 2001-2011 database of claims, payroll, and demographic data from 27 large U.S. employers. Employees aged 18-64 years taking UA medications with health plan enrollment from 6 months before the index UA medication prescription to 12 months after were included. Persistence (days until first ≥ 30-day gap in UA medication supply) and adherence (percentage of the annual post-index period with available medication) were assessed using survival analysis and generalized linear regression models that controlled for demographics, job-related factors, copay, and pre-index employee benefit utilization.  RESULTS: 2,960 employees met study criteria. Median days of persistence by OAB subtype were 76, 82, 43, 66, and 60 for urge UI, mixed UI, nocturnal UI, other OAB, and no diagnosis, respectively (P less than 0.05 for urge and mixed vs. no diagnosis). Increased copay and copay as a percentage of salary were associated with lower adherence. Employees with ≥ 80% adherence had lower medical, SL, and STD and higher overall drug costs than employees with less than 80% adherence.  CONCLUSIONS: This study suggests potential economic benefits to employers from increased UA adherence. Additionally, economic factors such as ability to pay influence adherence to UA medications.

Economic burden of urge urinary incontinence in the workplace.

OBJECTIVE: Quantify incremental employee medical, pharmacy, sick leave, short- and long-term disability, and workers' compensation costs, absence days, and turnover associated with urge urinary incontinence (UUI) in employees. METHODS: This retrospective 2001-2011 database comparison of employees with UUI versus those without UUI (controls) included employees aged 18.5 to 64.0 years at index, with 6-month preindex and 12-month postindex health plan enrollment. Logistic and generalized linear models measured postindex costs, absences, and turnover. RESULTS: The study included 1448 employees with UUI and 337,796 controls. Employees with UUI had statistically significantly higher medical (131% higher), pharmacy (52%), sick leave (30%), and short-term disability (74%) costs and more sick leave (22%) and short-term disability (99%) days than controls (all P < 0.02). CONCLUSIONS: Employees with UUI had 117% greater medical and pharmacy costs, 47% greater total absence costs, and 63% more absence days than employees without UUI.

Work-related and health care cost burden of community-acquired pneumonia in an employed population.

OBJECTIVE: To estimate community-acquired pneumonia (CAP) incidence, turnover, episode length, inpatient length-of-stay, and cost burden. METHODS: Using 2007 to 2010 employee demographic, payroll, and claims data, CAP episodes were identified in employees aged 18 to 64 years. Semiannual medical, drug, sick leave, short-term disability (STD), long-term disability, and workers' compensation costs and absence days were compared between employees with and without CAP (controls) using two-part regression modeling. RESULTS: In a population of 250,000, the number of CAP episodes per 100,000 employees was 628. The incidence rate increased with age and comorbidity. CAP employees' turnover rate nearly doubled that of controls (P < 0.01). In every age and risk group, employees with CAP had significantly (P < 0.01) higher medical and drug costs than controls and double the STD costs and days (P < 0.05). CONCLUSIONS: CAP and underlying comorbidity are associated with increased medical, pharmacy, and STD costs and employee turnover rates.

Direct and indirect costs of women diagnosed with menopause symptoms.

OBJECTIVE: To quantify employee burden of those diagnosed with menopause symptoms. METHODS: This regression-based study analyzed 2001-to-2010 medical, pharmacy, sick leave, disability, workers' compensation, and productivity data of large US employers. A cohort of employed women with diagnosed menopause symptoms (DMS), aged more than 40 years, were identified using medical claims International Classification of Diseases, Ninth Revision, Clinical Modification codes 627.xx. Control employees were propensity matched on age, employer, plan enrollment length, and enrollment end date. RESULTS: The study included 17,322 in each cohort. Employees with DMS had significantly higher medical ($4315 vs $2972, P < 0.001), pharmacy ($1366 vs $908, P < 0.001), sick leave costs ($647 vs $599, P < 0.001), and sick leave days (3.57 vs 3.30, P < 0.001). Employees with DMS had 12.2% (P = 0.007) lower hourly productivity and 10.9% (P = 0.014) lower annual productivity than controls. CONCLUSIONS: Although all women experience menopause, women with DMS have significantly higher utilization and productivity burdens.

Annual incremental health benefit costs and absenteeism among employees with and without rheumatoid arthritis.

OBJECTIVE: To assess the impact of rheumatoid arthritis (RA) on absence time, absence payments, and other health benefit costs from the perspective of US employers. METHODS: Retrospective regression-controlled analysis of a database containing US employees' administrative health care and payroll data for those who were enrolled for at least 1 year in an employer-sponsored health insurance plan. RESULTS: Employees with RA (N = 2705) had $4687 greater average annual medical and prescription drug costs (P < 0.0001) and $525 greater (P < 0.05) indirect costs (because of sick leave, short- and long-term disability, and workers' compensation absences) than controls (N = 338,035). Compared with controls, the employees with RA used an additional 3.58 annual absence days, including 1.2 more sick leave and 1.91 more short-term disability days (both P < 0.0001). CONCLUSION: Employees with RA have greater costs across all benefits than employees without RA.

Costs, work absence, and adherence in patients with partial onset seizures prescribed gabapentin or pregabalin.

BACKGROUND/OBJECTIVE: Few studies have examined cost of illness of epileptic partial onset seizures (POS) from the employer perspective or compared users of gabapentin and pregabalin in treatment of POS. This study compares pharmacotherapy, direct/indirect costs, and work absences of patients with POS newly started on gabapentin or pregabalin. METHODS: Data from employees and dependent spouses with POS starting treatment (index date) with either gabapentin or pregabalin were analyzed. Patients were required to have at least 6 months of health plan enrollment pre- and post-index. Regression modeling compared medical and prescription costs, sick leave (SL), short-term disability (STD), workers' compensation (WC) costs and absence days during the 6-month post-index period. Persistence, adherence (proportion of days covered), impact on adherence of copay, and copay as a percent of salary were modeled. RESULTS: Semiannual medical, drug, SL, STD, and WC costs for gabapentin vs. pregabalin cohorts were $10,306 vs. $9186, $2353 vs. $3387 (P=0.01), $552 vs. $342, $1280 vs. $580, and $170 vs. $30, respectively. SL days (10.8 vs. 1.5, P=0.04) and STD days (9.8 vs. 6.2) were lower in the pregabalin cohort. Persistence (median 94 vs. 70 days) and proportion with ≥ 80% adherence (30% vs. 15%, P=0.049) were greater in the pregabalin cohort. Adherence decreased as copay or copay as a percent of salary increased beyond specific levels in both cohorts. CONCLUSION: Despite higher acquisition costs for branded pregabalin over generic gabapentin, overall direct and indirect costs trended lower for pregabalin users. Additionally, pregabalin users had significantly fewer sick leave days and significantly higher adherence rates than gabapentin users.

Excess comorbidity prevalence and cost associated with functional dyspepsia in an employed population.

BACKGROUND: Limited published data exist on the associated comorbid conditions with functional dyspepsia (FD). AIMS: This study aimed to assess the prevalence, services, and costs related to comorbid conditions associated with FD and the risk of having FD for each comorbid condition. METHODS: A retrospective database analysis was undertaken using payroll data and adjudicated claims from January 1, 2001, through December 31, 2004 among >300,000 employees. Employees with FD were compared to propensity-score-matched employees without FD (controls). Outcome measures included the prevalence, costs, and utilization of health services for comorbid conditions as defined by the Agency for Healthcare Research and Quality (AHRQ) and the odds ratios of having FD from a multivariate model. RESULTS: FD employees (N = 1,669) and a 50:1 matched control cohort (N = 83,450) were compared. Compared to matched controls, FD employees were more likely to have all major diagnostic categories. Moreover, 199/261 of the AHRQ's specific categories were more common in the FD cohort. Annual medical costs for the FD cohort were greater than for controls in 155/261 (59%) specific categories and significantly greater (P ≤ 0.05) in 76 categories (29%). Similarly, services were greater for 179/261 (69%) specific categories and significantly greater (P ≤ 0.05) in 110 categories (42%). In a multivariate model, esophageal disorders, gastritis and duodenitis, and abdominal pain were the most associated with having FD (odds ratios 3.8, 3.7, and 3.6, respectively). Only hypertension complications and disorders of the teeth and jaw were significantly negatively associated with FD. CONCLUSION: There is unexplained excess comorbidity associated with FD which may be a major determining factor for excess healthcare services and costs.

Absenteeism and productivity among employees being treated for hepatitis C.

OBJECTIVES: To compare productivity, absence days, and absence costs for treated (HCV-Tx) and untreated (HCV-NoTx) US employees with hepatitis C virus (HCV) infection. STUDY DESIGN: Retrospective database study. METHODS: Employee records from multiple large employers in the United States with data about demographics, jobs, and healthcare use in the Human Capital Management Services database were assessed. HCV subjects were identified by International Classification of Diseases, 9th Revision codes. To test differences between cohorts, t tests and χ2 tests were used. Regression modeling was used to compare absence days, costs,and objectively measured productivity, while controlling for confounding factors. For HCV-Tx employees, the index date was the date of the first treatment with interferon, peginterferon, and/or ribavirin. For HCV-NoTx employees, the index date was the average date by company among HCV-Tx employees. Absence and productivity were measured from each employee's index date to the last date the employee was enrolled in health benefits coverage. RESULTS: A total of 441 HCV-Tx and 1223 HCV-NoTx employees were evaluated. HCV-Tx workers had 0.52 more total monthly absence days and $31.31 in additional monthly absence payments per employee than untreated employees. Treated employees' productivity was lower, with treated subjects processing 11.7% fewer units per hour and 17.4% fewer units per month than untreated employees. CONCLUSIONS: This study quantified the substantial indirect burden of illness associated with use of current HCV treatments. New treatments are needed with improved adverse effect profiles that result in reduced absence from work and improved productivity among HCV-infected persons.

Health outcomes and costs among employees with fibromyalgia treated with pregabalin vs. standard of care.

OBJECTIVE: To compare comorbidities, drug use, benefit costs, absences, medication persistence/adherence between employees with fibromyalgia initiating treatment with pregabalin (PGB) vs. antidepressant Standard of Care ([SOC] amitriptyline, duloxetine, or venlafaxine). METHODS: Retrospective study of 240 adults initiating PGB or SOC after 7/1/2007. Multivariate regression models on propensity-score-matched cohorts compared postindex costs, absences, and adherence between cohorts. RESULTS: Pregabalin users had significantly more preindex muscle pain and dizziness and less depression than SOC (each P < 0.05). Use of some non-PBG/SOC drugs differed. No differences were found in total medical, drug, or absenteeism cost. PGB had more sick leave (9.8 vs. 6.8 days, P = 0.04), but other absence types were similar. All adherence metrics were nonsignificantly greater for PGB vs. SOC. CONCLUSION: Despite several comorbidity and drug use differences, most employee benefit outcomes and adherence did not differ between the cohorts.

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.

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-ß1a-IM = Avonex = 'A', IFN-ß1b = Betaseron = 'B', IFN-ß1a-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.

Medication adherence with disease modifying treatments for multiple sclerosis among US employees.

OBJECTIVE: Medication adherence in chronic diseases like multiple sclerosis (MS) plays an important role in predicting long-term outcomes, yet existing data on adherence in employee populations are not found. The objective of this study is to compare adherence among employees treated with disease modifying treatments (DMTs) for MS in the year following treatment initiation. METHODS: A healthcare claims database of US employees from 2001 to 2008 was used to identify patients with MS based on two or more DMT prescriptions or one DMT prescription with an MS diagnosis (ICD-9 340.xx). Employees continuously employed and with health plan coverage for 1 year following DMT initiation were eligible. Two measures were used in estimating adherence after DMT initiation: (1) persistence (the number of days from DMT initiation to the first 30-day gap in supply) and, (2) annual compliance, assessed by the medication possession ratio (MPR = number of days with a medication supply in the year divided by 365 days). Wilcoxon tests on time-to-event data and t-tests were used to compare persistence and MPR, respectively, between DMT groups. Other measures of resource utilization were also compared. RESULTS: Overall, 358 employees [179 interferon [IFN]-ß1a-IM (Avonex* = 'A'); 63 IFN-ß1b (Betaseron† = 'B'); 20 IFN-ß1a-SC (Rebif‡ = 'R'); 96 glatiramer acetate (Copaxone§ = 'C')] were eligible for analysis. No significant differences in age, gender, and certain job-related variables existed between cohorts. Persistence was better for 'A' than 'B' (p = 0.039), 'C' (p = 0.0007), and 'R' (p = 0.130). At 1 year, a greater proportion of 'A' employees were persistent (60.34%) than 'B' (42.86%, p = 0.016), 'C' (42.71%, p = 0.0052), and 'R' (45.00%, p = 0.190). 'A' also had the highest MPR (0.782) which was significantly higher than 'C' (MPR = 0.698, p = 0.0160) and statistically equivalent to 'B' (MPR = 0.705, p = 0.0576) and 'R' (MPR = 0.761, p = 0.7347). LIMITATIONS: The study has limitations characteristic of administrative claims database studies and small sample sizes. The population may not be representative of undiagnosed/untreated MS patients, those not able to maintain employment, and those not using the initial therapy. CONCLUSIONS/RELEVANCE: Among employees treated with 'A', 'B', 'C', and 'R' for MS, 'A' patients had significantly greater medication adherence.

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

UNLABELLED: 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.

The burden of atrial fibrillation and other cardiac arrhythmias in an employed population: associated costs, absences, and objective productivity loss.

OBJECTIVE: To establish the burden of atrial fibrillation (AF) and other cardiac arrhythmias (CA) in an employed population. METHODS: Regression model analysis comparing objective work output, employee turnover, comorbidity prevalence, total health benefit (health care, drug, sick leave, disability, workers' compensation) costs, and absence days for AF versus Non-AF and CA versus Non-CA cohorts, while controlling for differences in patient characteristics. RESULTS: Cohort sizes were 1403 (AF), 323,333 (Non-AF), 4497 (CA), and 318,917 (Non-CA) employees. Annual AF benefit costs exceeded Non-AF costs by $3958. CA costs exceeded Non-CA costs by $2897. AF and CA cohorts had significantly more sick leave and short-term disability absence days than Non-AF and Non-CA cohorts, respectively. Annual CA work output was significantly lower than Non-CA output. CONCLUSIONS: AF and CA place significant cost, absence, and productivity burdens on employers.