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PHARMACY & THERAPEUTICS SOCIETY
 
Volume 17: 657-664     October 2011     Number 10
Absenteeism and Productivity Among Employees Being Treated for Hepatitis C
Richard A. Brook, MS, MBA; Nathan L. Kleinman, PhD; Jun Su, MD, MSc; Patricia K. Corey-Lisle, PhD; and Uchenna H. Iloeje, MD, MPH

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 x2 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.

 

(Am J Manag Care. 2011;17(10):657-664)

Related Articles
The hepatitis C virus (HCV) is a major cause of chronic liver disease in the United States and worldwide. According to the Centers for Disease Control and Prevention, HCV infection is the most common chronic blood-borne viral infection in the United States.1,2 Based on the Third National Health and Nutrition Examination Survey (1988-1994), 3.9 million Americans, 1.8% of the total population, have been infected with HCV; and 2.7 million Americans are chronically infected and likely to progress to a more advanced disease.2 Globally, about 170 million people are chronically infected by this virus, with 3 to 4 million new infections expected each year.3 Unlike hepatitis B infection, no vaccine is currently available to prevent HCV infections.4

Chronic HCV infection develops in 80% of acutely infected patients. With an incubation period ranging from 15 to 150 days, acute HCV infections commonly present with symptoms of fatigue and jaundice. However, the majority of HCV cases (60%-70%) are asymptomatic, including those that develop into chronic infections. Chronic infection results in the development of cirrhosis in between 10% and 20% of these patients, with liver cancer developing in between 1% and 5% of this population over a period of 20 to 30 years.3 HCV is estimated to cause 10,000 to 12,000 deaths annually in the United States.4 Wong and colleagues5 project as many as 16,500 deaths per year in the United States, with 27,200 total deaths from liver cancer alone between 2010 and 2019. Additionally, this model estimates 1.83 million years of life lost, with a total direct medical cost of 10.7 billion dollars and a US societal cost of premature mortality for those younger than 65 years of $54.2 billion.5 Furthermore, the prevalence of HCV is increasing in some populations.6

HCV-infected patients have been reported to experience a lower health-related quality of life compared with the general population.7-9 Symptomatic HCV infection adversely impacts psychological wellbeing, functional health status, and general health perception of those afflicted.10 Cognitive impairment or “difficulty in thinking” has been described in approximately one-third of chronic HCV patients, independent of liver function status.11 Work performance and productivity may also be diminished in these patients.12,13

The majority of HCV patients in the United States are infected with genotypes 1a or 1b and treatment guidelines are genotype specific. The current standard of care for chronic HCV infection is a combination of peginterferon plus ribavirin.4,14 Generally, genotype 1 infection requires higher dosages and more prolonged therapy than genotypes 2 or 3. Response to treatment is considered “sustained” if HCV remains undetectable for 6 months or longer after the completion of therapy.4 Relapses and the long-term sequelae associated with disease progression are rare at this point.4 It must be noted that this combination treatment is associated with significant and often dose-limiting adverse events and has been documented to negatively affect both patients’ quality of life and worker productivity using validated scales in randomized controlled clinical trials.12,13 Toxicity associated with ribavirin and a-interferon may require dose modification or discontinuation of therapy in 2% to 10% of patients.14,15

Prior research on outcomes of HCV infection is limited, especially from the employer’s perspective.12,16 Little has been reported on the impact of HCV infection on productivity and the incremental impact of treatment on productivity outside of the randomized clinical trial setting.12 Recently, Su et al16 compared controls without HCV with HCV-infected workers and found that those with HCV had lower productivity and more absence days. Reduced worker productivity due to treatment side effects during therapy has also been reported.12,13 Other prior studies comparing treated and untreated HCV populations have been based on small sample sizes,17 persons coinfected with HIV,18 specialty populations such as Veterans Affairs patients,19 or individuals with substance abuse issues.20-22

The goal of this study was to assess the impact of HCV treatment with interferon, peginterferon, and/or ribavirin on absenteeism (lost time and costs associated with workforce absenteeism) and on worker productivity using objectively captured data from an employed population.

METHODS

This retrospective study was based on longitudinal data from the Human Capital Management Services Research Reference Database (HCMS RRDb) of multiple, geographically diverse, US-based employers. The HCMS RRDb contains adjudicated health insurance and prescription drug claims, with demographics and payroll information from more than 670,000 employees over the period from 2001 to 2008. The HCMS RRDb is representative of the 2004 US Employed Civilian Labor Force (139.2 million) in terms of age and sex, and has been used in prior published research.23-25 Confidentiality and anonymity of subject-level data in this study were maintained in accordance with Health Insurance Portability and Accountability Act guidelines.26

Study Groups

Using medical insurance claims data, the following International Classification of Diseases, 9th Revision (ICD-9) codes were used to identify employees with HCV: 070.41 (acute hepatitis C with hepatic coma), 070.44 (chronic hepatitis C with hepatic coma), 070.51 (acute hepatitis C without mention of hepatic coma), 070.54 (chronic hepatitis C without mention of hepatic coma), or 070.7x (unspecified viral hepatitis C). Employees in the treatment group (HCV-Tx) were those with HCV and 1 or more prescriptions for interferon, peginterferon, and/or ribavirin. These employees were compared with HCVinfected employees who did not receive interferon, peginterferon, and/or ribavirin treatment (HCV-NoTx).

Analyses focused on the time after each subject’s index date. For the HCV-Tx cohort, the index date was defined based on the start of therapy. Because the nontreated cohort (HCVNoTx) did not receive therapy, the index date was defined as the average index date (by company) of the HCV-Tx cohort.

Subjects in both cohorts were required to be more than 18 years old on their index date, to have a minimum of 1 month of continuous health plan enrollment after their index date, and to be retained as employees to the last date of health plan enrollment.

Outcome Measures


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