Effect of Reliable Recovery on Health Care Costs and Productivity Losses in Emotional Disorders.

Despite the high economic costs associated with emotional disorders, relatively few studies have examined the variation in costs according to whether the patient has achieved a reliable recovery. The aim of this study was to explore differences in health care costs and productivity losses between primary care patients from a previous randomized controlled trial (RCT)-PsicAP-with emotional symptoms who achieved a reliable recovery and those who did not after transdiagnostic cognitive-behavioral therapy (TD-CBT) plus treatment as usual (TAU) or TAU alone. Sociodemographic and cost data were obtained for 134 participants treated at five primary care centers in Madrid for the 12-month posttreatment period. Reliable recovery rates were higher in the patients who received TD-CBT + TAU versus TAU alone (66% vs. 34%, respectively; chi-square = 13.78, df = 1, p < .001). Patients who did not achieve reliable recovery incurred more costs, especially associated with general practitioner consultations (t = 3.01, df = 132, p = .003), use of emergency departments (t = 2.20, df = 132, p = .030), total health care costs (t = 2.01, df = 132, p = .040), and sick leaves (t = 1.97, df = 132, p = .048). These findings underscore the societal importance of achieving a reliable recovery in patients with emotional disorders, and further support the value of adding TD-CBT to TAU in the primary care setting.

Savings in social expenditures for work incapacity in patients with inflammatory bowel disease depend on access to innovative therapies in Poland.

OBJECTIVES: Inflammatory bowel diseases (IBD) are an increasing burden for societies. We examined Polish Social Insurance Institution (ZUS) work incapacity expenditures for people with IBD compared with the general population. METHODS: Aggregate data were obtained on ZUS expenditures between 2012 and 2021 in Polish zlotys (PLN). Annual work incapacity benefit expenditures were analyzed and IBD benefit expenditures were examined relative to innovative IBD drug utilization in individual provinces. RESULTS: Between 2012 and 2021, annual ZUS expenditures per person increased, while expenditures per IBD patient decreased. Proportionally, absenteeism was the largest ZUS expenditure in the general population, while disability pensions were the largest in the IBD population. ZUS expenditures due to absenteeism in the general population increased by PLN 282 per person; those due to disability pensions decreased by PLN 85. Disability pension spending due to Crohn's disease (CD) and ulcerative colitis (UC) decreased by PLN 371 and PLN 284, respectively, while absenteeism spending per person with CD and UC decreased (PLN 58 and PLN 35, respectively). Nationwide in 2021, 8.5% of people with CD and 1.9% of those with UC received innovative drugs. The percentage of people receiving innovative drugs and ZUS expenditure per person were inversely related in 9/16 provinces for CD and 5/16 for UC. CONCLUSION: Polish state spending on work incapacity benefits increased in the general population but decreased in people with IBD between 2012 and 2021. Use of innovative drugs was associated with reduced spending per person with IBD in some provinces.

Cancer Screening after the Adoption of Paid-Sick-Leave Mandates.

BACKGROUND: By the end of 2022, nearly 20 million workers in the United States have gained paid-sick-leave coverage from mandates that require employers to provide benefits to qualified workers, including paid time off for the use of preventive services. Although the lack of paid-sick-leave coverage may hinder access to preventive care, current evidence is insufficient to draw meaningful conclusions about its relationship to cancer screening. METHODS: We examined the association between paid-sick-leave mandates and screening for breast and colorectal cancers by comparing changes in 12- and 24-month rates of colorectal-cancer screening and mammography between workers residing in metropolitan statistical areas (MSAs) that have been affected by paid-sick-leave mandates (exposed MSAs) and workers residing in unexposed MSAs. The comparisons were conducted with the use of administrative medical-claims data for approximately 2 million private-sector employees from 2012 through 2019. RESULTS: Paid-sick-leave mandates were present in 61 MSAs in our sample. Screening rates were similar in the exposed and unexposed MSAs before mandate adoption. In the adjusted analysis, cancer-screening rates were higher among workers residing in exposed MSAs than among those in unexposed MSAs by 1.31 percentage points (95% confidence interval [CI], 0.28 to 2.34) for 12-month colorectal cancer screening, 1.56 percentage points (95% CI, 0.33 to 2.79) for 24-month colorectal cancer screening, 1.22 percentage points (95% CI, -0.20 to 2.64) for 12-month mammography, and 2.07 percentage points (95% CI, 0.15 to 3.99) for 24-month mammography. CONCLUSIONS: In a sample of private-sector workers in the United States, cancer-screening rates were higher among those residing in MSAs exposed to paid-sick-leave mandates than among those residing in unexposed MSAs. Our results suggest that a lack of paid-sick-leave coverage presents a barrier to cancer screening. (Funded by the National Cancer Institute.).

Integrating quantitative and qualitative approaches to assess wintertime illness-related absenteeism and its direct and indirect costs among the private sector in Ulaanbaatar.

Causes for employee absenteeism vary. The commonest cause of work absenteeism is "illness-related." Mongolia's capital city, Ulaanbaatar, experiences high employee absenteeism during the winter than during other seasons due to the combination of extreme cold and extreme air pollution. We identified direct and indirect costs of absenteeism attributed to air pollution among private-sector employees in Ulaanbaatar. Using a purposive sampling design, we obtained questionnaire data for 1,330 employees working for private-sector companies spanning six economic sectors. We conducted 26 employee focus groups and 20 individual employer in-depth interviews. We used both quantitative and qualitative instruments to characterize the direct and indirect costs of absence due to illnesses attributed to severe air pollution during wintertime. Female employees and employees with a young child at home were more likely to be absent. Respiratory diseases accounted for the majority of reported air pollution-related illnesses. All participants perceived that air pollution adversely affected their health. Individual employee direct costs related to absence totaled 875,000 MNT ($307.10) for an average of three instances of three-day illness-related absences during the winter. This sum included diagnostic and doctor visit-related, medication costs and hospitalization costs. Non-healthcare-related direct cost (transportation) per absence was 50,000₮ ($17.60). Individual indirect costs included the value of lost wages for the typical 3-day absence, amounting to 120,000₮ ($42.10). These total costs to employees, therefore, may amount to as much as 10% of annual income. The majority of sick absences were unpaid. Overall, the cost of wintertime absences is substantial and fell disproportionately on female employees with young children.

Economic burden of highly active relapsing-remitting multiple sclerosis patients in the French national health insurance database.

BACKGROUND: As healthcare management of highly active-relapsing-remitting multiple sclerosis (HA-RRMS) patients is more complex than for the whole multiple sclerosis (MS) population, this study assessed the related economic burden from a National Health Insurance's (NHI's) perspective. RESEARCH DESIGN AND METHODS: Study based on French NHI databases, using individual data on billing and reimbursement of outpatient and hospital healthcare consumption, paid sick leave and disability pension, over 2010-2017. RESULTS: Of the 9,596 HA-RRMS adult patients, data from 7,960 patients were analyzed with at least 2 years of follow-up. Mean annual cost/patient was €29,813. Drugs represented 40% of the cost, hospital care 33%, disability pensions 9%, and all healthcare professionals' visits combined 8%. Among 3,024 patients under 60 years-old with disability pension, disability pension cost €7,168/patient/year. Among 3,807 patients with paid sick leave, sick leave cost €1,956/patient/year. Mean costs were €2,246/patient higher the first year and increased by €1,444 between 2010 and 2015, with a €5,188 increase in drug-related expenditures and a €634 increase in healthcare professionals' visits expenditures but a €4,529 decrease in hospital care expenditures. CONCLUSIONS: The cost of health care sick leaves, and disability pensions of HA-RRMS patients was about twice as high as previously reported cost of MS patients.

Paid sick leave benefits among essential frontline workers serving people experiencing homelessness in Canada during the COVID-19 pandemic.

OBJECTIVES: This study examined the prevalence and factors associated with paid sick leave benefits among direct service providers who work with people experiencing homelessness. STUDY DESIGN: Cross-sectional study using an online survey disseminated during the second wave of the COVID-19 pandemic in Canada. METHODS: Survey data from 572 direct service providers working in the homeless, supportive housing, and harm reduction service sectors were analyzed for this study. Univariate and multivariate logistic regression models were used to examine predictors of paid sick leave benefits. RESULTS: One hundred one (17.7%) participants did not have any paid sick leave benefits. In the univariate models, paid sick leave was associated with older age, greater family income, full-time work, specific employment settings (supportive housing and not emergency shelters or harm reduction programs), having a regular medical doctor, and fewer occupational impacts of the COVID-19 pandemic. Older age, full-time work, and non-receipt of emergency financial benefits remained statistically significant predictors in the multivariate model. CONCLUSIONS: Although the majority of service providers working with people experiencing homelessness have some amount of paid sick leave benefits, there is a precariously employed subset of individuals who are younger and working part-time in the sector. Temporary expansion of paid sick leave and removal of waiting periods for new employees to qualify for benefits are recommended.

Friction Costs and the Chain of Vacancies Problem: A Novel Vacancy Multiplier Solution.

OBJECTIVES: A key criticism of applying the friction cost approach (FCA) to productivity cost estimation is its focus on a single friction period. A more accurate estimate of the friction cost of worker absence requires consideration of the chain of secondary vacancies arising from the opening of a new primary vacancy. Currently, empirical evidence on this is almost absent. We suggest an original approach to empirically estimate productivity costs that include a chain of secondary vacancies. METHODS: The vacancy multiplier is based on labor market flows and transition probabilities between states of employment, unemployment, and economic inactivity. It is a summed infinite geometric series using a common ratio et - the probability of an employed person filling a new job vacancy in a given year. We report vacancy multipliers for 30 European countries for 2011-2019. RESULTS: The average multiplier across Europe is 2.21 (standard deviation [SD] = 0.40) in 2019, meaning that every new primary vacancy created a chain of secondary vacancies that increased the primary friction cost by a factor of 2.21. The equivalent multiplier is 1.99 (SD = 0.37) between 2011 and 2019. Romania had the lowest country-specific multiplier (1.11 in 2011), and Greece the highest (4.51 in 2011). CONCLUSIONS: Our results highlight the extent of underestimation of current FCA costs, comprise a resource for future researchers, and provide an implementable formula to compute the multiplier for other countries.

Costs of Health Service Use among Unemployed and Underemployed People with Mental Health Problems.

BACKGROUND: Unemployment is associated with a high risk of experiencing mental illness. This can lead to stigmatisation, reduced quality of life, and long-term costs like increased healthcare expenditure and productivity losses for society as a whole. Previous research indicates evidence for an association between unemployment and higher mental health service costs, but there is insufficient information available for the German healthcare system. AIM OF THE STUDY: This study aims to identify costs and cost drivers for health and social service use among unemployed people with mental health problems in Germany. METHODS: A sample of 270 persons participated at baseline and six-month-follow-up. Healthcare and social service use was assessed using the Client Socio-Demographic and Service Receipt Inventory. Descriptive cost analysis was performed. Associations between costs and potential cost drivers were tested using structural equation modelling. RESULTS: Direct mean costs for 12 months range from EUR 1265.13 (somatic costs) to EUR 2206.38 (psychiatric costs) to EUR 3020.70 (total costs) per person. Path coefficients indicate direct positive effects from the latent variable mental health burden (MHB) on stigma stress, somatic symptoms, and sick leave. DISCUSSION: The hypothesis that unemployed people with mental health problems seek help for somatic symptoms rather than psychiatric symptoms was not supported. Associations between MHB and costs strongly mediated by sick leave indicate a central function of healthcare provision as being confirmation of the inability to work. IMPLICATIONS FOR HEALTH POLICIES: Targeted interventions to ensure early help-seeking and reduce stigma remain of key importance in reducing long-term societal costs. IMPLICATIONS FOR FURTHER RESEARCH: Future research should explore attitudes regarding effective treatment for the target group.

Clinical and Economic Effects of Widespread Rapid Testing to Decrease SARS-CoV-2 Transmission.

BACKGROUND: The value of frequent, rapid testing to reduce community transmission of SARS-CoV-2 is poorly understood. OBJECTIVE: To define performance standards and predict the clinical, epidemiologic, and economic outcomes of nationwide, home-based antigen testing. DESIGN: A simple compartmental epidemic model that estimated viral transmission, portrayed disease progression, and forecast resource use, with and without testing. DATA SOURCES: Parameter values and ranges as informed by Centers for Disease Control and Prevention guidance and published literature. TARGET POPULATION: U.S. population. TIME HORIZON: 60 days. PERSPECTIVE: Societal; costs included testing, inpatient care, and lost workdays. INTERVENTION: Home-based SARS-CoV-2 antigen testing. OUTCOME MEASURES: Cumulative infections and deaths, number of persons isolated and hospitalized, and total costs. RESULTS OF BASE-CASE ANALYSIS: Without a testing intervention, the model anticipates 11.6 million infections, 119 000 deaths, and $10.1 billion in costs ($6.5 billion in inpatient care and $3.5 billion in lost productivity) over a 60-day horizon. Weekly availability of testing would avert 2.8 million infections and 15 700 deaths, increasing costs by $22.3 billion. Lower inpatient outlays ($5.9 billion) would partially offset additional testing expenditures ($12.5 billion) and workdays lost ($14.0 billion), yielding incremental cost-effectiveness ratios of $7890 per infection averted and $1 430 000 per death averted. RESULTS OF SENSITIVITY ANALYSIS: Outcome estimates vary widely under different behavioral assumptions and testing frequencies. However, key findings persist across all scenarios, with large reductions in infections, mortality, and hospitalizations. Costs per death averted are roughly an order of magnitude lower than commonly accepted willingness-to-pay values per statistical life saved ($5 to $17 million). LIMITATIONS: Analysis was restricted to at-home testing. There are uncertainties concerning test performance. CONCLUSION: High-frequency home testing for SARS-CoV-2 with an inexpensive, imperfect test could contribute to pandemic control at justifiable cost and warrants consideration as part of a national containment strategy. PRIMARY FUNDING SOURCE: National Institutes of Health.

Surto de conjuntivite aguda no período de 2017-2018 em Recife, Brasil / Outbreak of acute conjunctivitis in the period 2017-2018 in Recife, Brazil

RESUMO Objetivo: Avaliar o perfil clínico, epidemiológico e o impacto econômico do surto de conjuntivite no período 2017-2018 no município de Recife-PE. Métodos: Estudo transversal com base na análise de prontuários de pacientes com diagnóstico de conjuntivite, atendidos na emergência da Fundação Altino Ventura entre dezembro/2017 e março/2018. Os dados coletados incluíram manifestações oculares no exame, complicações subsequentes, manejo e dias de licença médica. Resultados: Dos 12.712 pacientes atendidos na FAV entre dezembro de 2017 e março de 2018, 6.359 (50,0%) foram diagnosticados com conjuntivite, dos quais 3.543 pacientes (55,7%) foram atendimentos únicos. A média de idade dos pacientes ao atendimento foi de 29,5 ± 14,1 anos (variação, 1-85 anos), com distribuição semelhante entre os sexos (2.288 casos [50,1%] masculino; 2.282 casos [49,9%] feminino). O diagnóstico mais comum foi conjuntivite sem pseudomembrana (5.645 casos [88,8%]). Hiperemia conjuntival (6.278 casos [98,7%]) e reação folicular (6.255 casos [98,4%]) foram os achados mais frequentes ao exame. A complicação mais frequente foi pseudomembrana (1.062 casos [16,7%]). Os colírios lubrificantes (4.308 [67,7%]) e os colírios de associação antibiótico com corticoide (2.033 [32%]) foram os mais prescritos no tratamento. A média de dias de atestado médico foi de 4,8 ± 2,9 dias (variação, 1- 47 dias) e a perda de produtividade estimada em R$1.159.329,14. Conclusão: O surto de conjuntivite em Pernambuco foi responsável por metade das consultas em um pronto-socorro oftalmológico. Surtos de conjuntivite podem causar um impacto econômico, uma vez que afeta principalmente adultos jovens em idade produtiva. As características clínicas observadas sugerem um surto de conjuntivite de etiologia viral.

Abstract Purpose: To evaluate the epidemiological and clinical profile and economic impact of the acute conjunctivitis outbreak in the period of 2017-2018 in Recife-PE. Methods: Cross-sectional study based on the analysis of medical records of patients diagnosed with conjunctivitis at the emergency room of the Altino Ventura Foundation (FAV) between December 2017 and March 2018. The collected data included ocular manifestations at examination, subsequent complications, management, and days of sick leave. Results: Out of 12,712 patients assisted at FAV from December 2017 to March 2018, 6,359 (50.0%) were diagnosed with conjunctivitis. The mean age of patients was 29.5 ± 14.1 years (range, 01-85 years), with similar distribution between sex (2,288 50.1% male; 2,282 49.9% female). The most common diagnosis was non-pseudomembranous conjunctivitis (5,645 cases 88.8%). Conjunctival hyperemia (6,278 cases 98.7%) and follicular reaction (6,255 cases 98.4%) were the most frequent ocular findings. The most common complication was pseudomembrane in 1,062 cases (16.7%). Lubricants (4,308 67.7%) and antibiotic associated to corticosteroid eyedrops (2,033 32.0%) were the most prescribed medications. The average days of sick leave per patient was 4.8 ± 2.9 days (range, 1- 47 days) and the productivity loss estimated in R$1.159.329,14. Conclusion: The conjunctivitis outbreak in Pernambuco, Brazil was responsible for half of the consultations in an ophthalmic emergency room. Conjunctivitis outbreaks may cause an economic impact as it mostly affects young adults in their productive ages and take in average a 5-day sick leave. The clinical characteristics observed suggest an outbreak of conjunctivitis of viral etiology.

Sickness absence, disability pension and economic situation after a spontaneous subarachnoid haemorrhage among people of working age: a Swedish longitudinal nationwide cohort study.

OBJECTIVES: The aim was to describe the course of sickness absence (SA), disability pension (DP) and work-related economic situation defined as earnings (EA) and disposable income (DI), after spontaneous subarachnoid haemorrhage (SAH). Associations of SA, DP, EA and DI with demographic factors were also studied. DESIGN: A longitudinal cohort study of all 1932 people in Sweden who in January 2005 to December 2010 had a first time SAH when aged 17 to 64 years and survived during the 3-year follow-up. Microdata from four nationwide administrative registers were used. MAIN OUTCOME MEASURES: Primary outcome was the presence of SA and DP and how this changed during the study period of 5 years (the year before, the year of SAH and the following 3 years). The secondary outcome was the development of the income variables EA and DI. Demographic factors analysed were sex, age, source of bleeding, country of birth, family situation, educational level and type of living area. RESULTS: The year before the SAH, 7.9% of women and 4.6% of men had some SA registered (p<0.004). A model consisting of female sex, higher education and living single predicted having SA that year. At the end of the follow-up, 39.2% of women and 28.3% of men had SA and/or DP (p<0.0001). A model consisting of female sex, living in a village/ rural area and having a defined bleeding source for the SAH was predicting having SA and/or DP at end of follow-up. The levels of EA decreased, while DI increased during follow-up and were at the end of follow-up associated with age, sex, type of living area, country of birth, educational level and family situation. The women's EA was lower than the men's during all years. CONCLUSIONS: SAH influenced future SA, DP, as well as EA. Both SA, DP and the economic variables studied were predicted by models including sex.

Degree of employment, sick leave, and costs following notification of occupational contact dermatitis-A register-based study.

BACKGROUND: Occupational contact dermatitis (OCD) is the most commonly recognized occupational disease in Denmark. OBJECTIVES: To examine the impact of recognized OCD on degree of employment, sick leave, unemployment, and job change. METHODS: Data on all recognized individuals with OCD notified in Denmark between 2010 and 2015 (n = 8940) were linked to information on social transfer payments in the years before and after notification. The number of weeks on unemployment benefits or sick leave and the degree of employment during the 2 years prior to notification was compared with the 2 years following notification. RESULTS: The degree of employment decreased on average 8.9 work-hours/month, corresponding to an average annual loss of income per worker of approximately €1570. The average number of weeks that workers were receiving unemployment benefits and paid long-term sick leave rose by 2.5 and 3.4 weeks, respectively, corresponding to an average additional annual cost per worker of approximately €420 and €770, respectively. Longer case-processing time was significantly associated with lower degree of employment and higher levels of unemployment and sick leave. CONCLUSIONS: OCD has a significant negative impact on employment and economics, thus highlighting the need for a national, strategic action plan for effective prevention of OCD.

Absenteeism and indirect costs during the year following the diagnosis of an operable breast cancer: A prospective multicentric cohort study.

BACKGROUND: Diseases consequence on individual work as much as consequences of being absent from work are matters of interest for decision makers. METHODS: We analyzed lengths of absenteeism and related indirect costs for patients with a paid activity in the year following the diagnosis of early stage breast cancer, in the prospective OPTISOINS01 cohort. Both human capital and friction costs approach were considered for the valuation of lost working days (LWD). For the analysis, the friction period was estimated from recent French data. The statistical analysis included simple and multiple linear regression to search for the determinants of absenteeism and indirect costs. RESULTS: 93 % of the patients had at least one period of sick leave, with on average 2 period and 186 days of sick leave. 24 % of the patients had a part-time resumption after their sick leave periods, during 114 days on average (i.e. 41 LWD). Estimated indirect costs were 22,722.00 € and 7,724.00 € per patient, respectively for the human capital and the friction cost approach. In the multiple linear regression model, factors associated with absenteeism were: the invasive nature of the tumor (p = .043), a mastectomy (p = .038), a surgery revision (p = .002), a chemotherapy (p = .027), being a manager (p = .025) or a craftsman (p = .005). CONCLUSION: Breast cancer lead to important lengths of absenteeism in the year following the diagnosis, but almost all patients were able to return to work. Using the friction cost or the human capital approach in the analysis led to an important gap in the results, highlighting the importance of considering both for such studies.

Association of long working hours and health-related productivity loss, and its differential impact by income level: A cross-sectional study of the Korean workers.

OBJECTIVES: We aimed to explore the association between long working hours and health-related productivity loss (HRPL), due to either sickness, absenteeism or presenteeism, stratified by household income level. METHODS: From January 2020 to February 2020, data were collected using a web-based questionnaire. A total of 4197 participants were randomly selected using the convenience sampling method. The nonparametric association between weekly working hours and HRPL was determined. Subsequently, a stratified analysis was conducted according to household income (1st, 2nd, and 3rd tertiles). Finally, the differences in HRPL of the different working hour groups (<40, 40, 40-51, and ≥52 hours) were investigated using a multivariate linear regression model. RESULTS: Long working hours were more significantly associated with HRPL, as compared to the 'standard' working hours (40 hours/week). A larger proportion of productivity loss was associated with the presenteeism of workers, rather than absenteeism. The relationship between HRPL and weekly working hours was more prominent in the lower household income group. CONCLUSIONS: The results of our study indicate that HRPL is associated with long working hours, especially in the lower household income group. Reducing the workload for the individual employee to a manageable level and restructuring sick leave policies to effectively counteract absenteeism and presenteeism may be a feasible option for better labor productivity and employee health.

Public Support for Social Safety-Net Policies for COVID-19 in the United States, April 2020.

Objectives. To examine public support for health insurance, income support, and unemployment policies during the initial phase of disease transmission and economic distress following the coronavirus disease 2019 (COVID-19) outbreak and to assess varying public support based on beliefs about the role of government.Methods. We fielded a nationally representative survey of US adults (n = 1468) from April 7, 2020, to April 13, 2020.Results. Of US adults, 77% supported paid sick leave, and a majority also supported universal health insurance, an increased minimum wage, and various unemployment support policies. Public support for an active government role in society to improve citizens' lives increased by 10 percentage points during this initial pandemic response relative to September 2019. Belief in a strong governmental role in society was associated with greater support for social safety-net policies.Conclusions. During the initial phase of the COVID-19 pandemic in early April 2020, most US adults favored a range of safety-net policies to ameliorate its negative health and economic consequences. For most safety-net policies, public support was highest among those favoring a stronger governmental role in society.

Healthcare use, work loss and total costs in incident and prevalent Crohn's disease and ulcerative colitis: results from a nationwide study in Sweden.

BACKGROUND: There are limited data on population-wide assessment of cost in Crohn's disease (CD) and ulcerative colitis (UC). AIM: To estimate the societal cost of actively treated CD and UC in Sweden. METHODS: We identified 10 117 prevalent CD and 19 762 prevalent UC patients, aged ≥18 years on 1 January 2014 and 4028 adult incident CD cases and 8659 adult incident UC cases (2010-2013) from Swedish Patient Register. Each case was matched to five population comparators. Healthcare costs were calculated from medications, outpatient visits, hospitalisations and surgery. Cost of productivity losses was derived from disability pension and sick leave. RESULTS: The mean annual societal costs per working-age patient (18-64 years) with CD and UC were $22 813 (vs $7533 per comparator) and $14 136 (vs $7351 per comparator), respectively. In patients aged ≥65 years, the mean annual costs of CD and UC were $9726 and $8072 vs $3875 and $4016 per comparator, respectively. The majority of cost for both CD (56%) and UC (59%) patients originated from productivity losses. Higher societal cost of working-age CD patients as compared to UC patients was related to greater utilisation of anti-TNF (22.2% vs 7.4%) and increased annual disability pension (44 days vs 25 days). Among incident CD and UC patients, the mean total cost over the first year per patient was over three times higher than comparators. CONCLUSION: In Sweden, the societal cost of incident and prevalent CD and UC patients was consistently two to three times higher than the general population.

Cost-effectiveness of robotic hysterectomy versus abdominal hysterectomy in early endometrial cancer.

OBJECTIVES: To compare total costs for hospital stay and post-operative recovery between robotic and abdominal hysterectomy in the treatment of early-stage endometrial cancer provided in an enhanced recovery after surgery (ERAS) setting. Costs were evaluated in relation to health impact, taking a societal perspective. METHODS: Cost analysis was based on data from an open randomized controlled trial in an ERAS setting at a Swedish tertiary referral university hospital: 50 women with low-risk endometrial cancer scheduled for surgery between February 2012 and May 2016 were included; 25 women were allocated to robotic and 25 to abdominal hysterectomy. We compared the total time in the operating theater, procedure costs, post-operative care, length of hospital stay, readmissions, informal care, and sick leave as well as the health-related quality of life until 6 weeks after surgery. The comparison was made by using the EuroQoL group form with five dimensions and three levels (EQ-5D). The primary outcome measure was total cost; secondary outcomes were quality-adjusted life-years (QALYs) and cost per QALY. The costs were calculated in Swedish Krona (SEK). RESULTS: Age (median (IQR) 68 (63-72) vs 67 (59-75) years), duration of hospital stay (ie, time to discharge criteria were met) (median (IQR) 36 (36-36) vs 36 (36-54) hours), and sick leave (median (IQR) 25 (17-30) vs 31 (36-54) days) did not differ between the robotic and abdominal group. Time of surgery was significantly longer in the robotic group than in the abdominal group (median (IQR) 70 (60-90) vs 56 (49-84) min; p<0.05). The robotic group recovered significantly faster as measured by the EQ-5D health index and gained 0.018 QALYs until 6 weeks after surgery. Total costs were 20% higher for the robotic procedure (SEK71 634 vs SEK59 319). The total cost per QALY gained for women in the robotic group was slightly under SEK700 000. CONCLUSIONS: Robotic hysterectomy used in an ERAS setting in the treatment of early endometrial cancer improved health within 6 weeks after the operation at a high cost for the health gained compared with abdominal hysterectomy. The productivity loss and informal care were lower for robotic hysterectomy, while healthcare had a higher procedure cost that could not be offset by the higher cost due to complications in the abdominal group.

Costo del subsidio por incapacidad temporal para el trabajo en pacientes con retinopatía diabética / Cost of temporary disability allowance for work in patients with diabetic retinopathy

OBJETIVO: Determinar el costo de subsidio por incapacidad temporal para el trabajo en pacientes con retinopatía diabética. MATERIAL Y MÉTODOS: Diseño de costo en expediente de pacientes con retinopatía diabética e incapacidad temporal para el trabajo. Se estudiaron 201 expedientes registrados en el servicio de salud en el trabajo. El costo total de la incapacidad incluyó salario nominal, días de incapacidad hasta la invalidez, y porcentaje pagado del salario nominal. RESULTADOS: El sueldo promedio pagado por día es €5.64. El promedio de días de incapacidad expedida por trabajador fue 129.52 (IC 95%; 114.81-144.23). El costo total promedio de incapacidad pagada por trabajador desde que presenta complicaciones oftalmológicas con repercusión laboral hasta que se expida el trámite por invalidez es €959.41 (IC 95%; 658.46-1,233.35). CONCLUSIÓN: La incapacidad temporal por retinopatía diabética consume recursos

OBJECTIVE: To determine the cost of temporary disability allowance for work in patients with diabetic retinopathy. MATERIAL AND METHODS: Cost design on file of patients with diabetic retinopathy and temporary incapacity for work. 201 files registered in the occupational health service were studied. The total cost of disability included nominal salary, days of disability, and the percentage paid of the salary. RESULTS: The average daily wage paid is €5.64. The average number of days of disability issued per worker was 129.52 (95% CI; 114.81- 144.23). The average total cost of disability paid per worker from the moment he presents ophthalmological complications with labor repercussions until the disability process is issued is €959.41 (IC 95%; 658.46-1,233.35). CONCLUSION: Temporary disability due to diabetic retinopathy consumes institutional resources that must be considered in budget planning