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Frequency, Severity of Sickle Cell Crises Linked to Productivity Losses at Work

Allison Inserro
A recent study found that patients with sickle cell who had more frequent or severe vaso-occlusive crises (VOCs) had greater absenteeism, overall productivity loss, and activity impairment than patients with less frequent or severe VOCs.
The frequency and severity of sickle cell vaso-occlusive crises (VOCs) are both associated with losses in work productivity, according to recent research presented at ISPOR 2019.  

Given what the authors said is a scarcity of quantitative research looking at this topic, an observational, cross-sectional, online survey was administered to 252 US adults with sickle cell disease (SCD), who self-reported having been diagnosed with SCD by a doctor. Results showed that patients with more frequent or severe VOCs missed more work in the week preceding survey administration than patients with less frequent or severe VOCs.

VOCs are painful episodes experienced by patients with SCD and are triggered by multi-cell adhesion or cell clusters that block or reduce blood flow.

A total of 251 patients with non-missing data on employment status were included in an analyses of work productivity (100 employed patients and 151 unemployed patients). The full sample (N = 252) was included in analyses of employment impacts.

VOC frequency and severity were assessed with the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me). The ASCQ-Me is a disease-specific measure of quality of life for patients with SCD that assesses 7 health domains. This study used scores obtained from the Pain Episodes domain, which was separated into 2 sub-domains: Pain Episode Frequency and Pain Episode Severity.

Patients also answered questions regarding employment impacts and completed the Workplace Productivity and Activity Impairment: Specific Health Problem (WPAI-SHP), a 6-item self-report instrument that measures 4 domains of impact on work productivity and activity impairment over the past 7 days due to a specific health problem.

The first question determines whether or not the patient is currently employed for pay.

The remaining items measure:
  • Absenteeism: Percentage of work time missed
  • Presenteeism: Percentage of time impaired while at work
  • Productivity loss: Percentage of overall work impairment resulting from
  • Presenteeism and absenteeism
  • Activity impairment: Percentage of activity impairment outside of work
Patients were stratified according to the frequency of VOCs over the past 12 months (0-3 VOCs; ≥4 VOCs) and the severity of VOCs based on pain severity.

Fifty-eight percent of patients reported that SCD negatively impacted their employment status; 73% of patients with ≥4 VOCs in the past year reported negative impacts compared to 45% of patients with zero to 3 VOCs. Patients with more frequent VOCs also reported greater absenteeism, overall productivity loss, and activity impairment than patients with less frequent VOCs (P <.05 for all).

Presenteeism did not differ according to VOC frequency (P = .132). Similar patterns were observed when examining reports of negative work impacts and WPAI scores according to VOC severity (P <.05 for all domains except presenteeism). 

Among all patients , those with ≥4 VOCs in the past 12 months reported greater activity impairment in the 7 days preceding survey administration than patients with zero to 3 VOCs (P <.05)

Among all patients, regardless of current employment status, 72.9% of those with ≥4 VOCs in the past 12 months reported that SCD negatively impacted their employment, compared to 44.8% of patients with zero to 3 VOCs (P <.001).

The authors said the research highlights the effects that VOCs may have on patients’ lives. Patients with more frequent or severe VOCs were more likely to have experienced losing a job or having to reduce work hours due to their SCD.

The study had some limitations, due to the nature of research based on self reports, and longitudinal data was not collected.


Rizio A, Bhor M, Lin X, et al. The relationship between vaso-occlusive crises and work productivity impairment in patients with sickle cell disease. Presented at: ISPOR 2019 Annual Meeting, New Orleans, Louisiana; May 18-22, 2019. Poster PND87. PRO55.

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