SICK LEAVE AND DISABILITY PENSION BEFORE AND AFTER INITIATION OF ANTIRHEUMATIC THERAPIES IN CLINICAL PRACTICE

Neovius M, Simard JF, Klareskog L & Askling J for the ARTIS Study GroupAnn Rheum Dis 2011;70(8):1407-14.PMID: 21518724

Background

• Antirheumatic treatmentAnti-TNF drugs constituted 5% of the total national drug expenditure in Sweden in 2009 (excl OTC-drugs)

• Work force participation Productivity losses in the RA population are large

Effects on productivity hold potential for offsetting some of the treatment cost

Background

Neovius M, Simard JF, Askling J. How large are the productivity losses in contemporary patients with RA, and how soon in relation to diagnosis do they develop? Ann Rheum Dis 2011;70(6):1010-15.

Objective

To assess annual days on sick leave & disability pension

before & after antirheumatic treatment initiation

in a nationwide RA cohort

Methods• Patients

– 19-60y old patients with RA initiating treatment in 1999-2007– Identified in the Swedish Rheumatology Quality Register (SRQ),

including the Swedish Biologics Register ARTIS

• Treatment cohorts– Mono-DMARD (n=2,796)– Combo-DMARD (n=973)– Biologics (n=4,787)

• Outcome– Annual net days on sick leave & disability pension (max 365 days)– From the Swedish Social Insurance Agency (1995 to 2010)

Prevalence of RA by Age and Sex(Jan 1, 2008; n=58 102)

Neovius, Simard & Askling for the ARTIS Study Group Ann Rheum Dis. 2011

45% <65y

Results

1. By Month

2. By Year

3. By Calendar Period

2 BY YEAR

Sick leave vs disability pensionMean days by therapyMedian days & distribution of days by therapy

2

2

Neovius M, Simard JF, Klareskog L & Askling J for the ARTIS Study Group, Ann Rheum Dis. 2011

3 BY CALENDAR PERIOD

Conclusion

• History of increasing productivity lossesThe patient group selected for therapy was characterized by a history of rapid increases in annual sick leave & disability pension days

• Breakpoint but no reversalTreatment was associated with a breakpoint in this pattern, but days off work remained far from the level observed before RA-diagnosis

• A large unmet need remainsIntervention appears to be needed earlier in the disease process

Related Articles from SRQ/ARTIS• Askling J, Fored CM, Geborek P, Jacobsson LT, van Vollenhoven R, Feltelius N, Lindblad S, Klareskog L

Swedish registers to examine drug safety and clinical issues in RA Ann Rheum Dis 2006;65(6):707-12.

• Neovius M, Simard JF, Askling J for the ARTIS Study Group How large are the productivity losses in contemporary patients with RA, and how soon in relation to diagnosis do they develop? Ann Rheum Dis 2011;70(6):1010-15.

• Simard JF, Arkema EV, Sundstrom A, Geborek P, Saxne T, Baecklund E, Coster L, Dackhammar C, Jacobsson L, Feltelius N, Lindblad S, Rantapaa-Dahlqvist S, Klareskog L, van Vollenhoven RF, Neovius M, Askling JTen years with biologics: to whom do data on effectiveness and safety apply? Rheumatology (Oxford) 2011;50(1):204-13.

• Neovius M, Simard JF, Askling J for the ARTIS Study GroupNationwide prevalence of rheumatoid arthritis and penetration of disease-modifying drugs in SwedenAnn Rheum Dis 2011;70(4):624-29.

• Neovius M, Simard J, Sundstrom A, Jacobsson L, Geborek P, Saxne T, Feltelius N, Klareskog L, Askling J. Generalisability of clinical registers used for drug safety and comparative effectiveness research: coverage of the Swedish Biologics Register. Ann Rheum Dis 2011;70(3):516-19.