Impact of gastro-oesophageal reflux disease on work productivity despite therapy with proton pump inhibitors in Germany

Gross M, Beckenbauer U, Burkowitz J, Walther H, Brueggenjuergen, Brueggenjuergen B

Description

Gastro-oesophageal reflux disease (GERD) is a common disorder with consequences for the patient's health-related quality of life (HRQoL). In Germany, few data are available on the impact of GERD on work-related productivity. Aim To study the impact of GERD on work productivity despite proton pump inhibitor (PPI) therapy and the association between productivity and symptom duration, severity, and HRQoL. Methods Retrospective data from randomly selected patients with chronic GERD symptoms, treated by office-based general practitioners or general internists with routine clinical care, were analyzed together with information from self-administered instruments assessing work productivity (WPAI-GERD), symptoms (RDQ), and HRQoL (QOLRAD). Results Reduced productivity was reported by 152 of 249 patients (61.0%), although 89.5% of them were treated with PPI. The reduction in work productivity was 18.5% in all patients and 30.3% in those with reduced productivity. Patients with impaired productivity showed a significantly lower HRQoL and more-severe symptoms of reflux disease. In all patients, the mean sick leave attributable to reflux symptoms was 0.6 hours in the previous seven days and 1.4 work days in the previous three months. Conclusion GERD has a substantial impact on work productivity in Germany, even in patients receiving routine clinical care and PPI therapy.

Sujets

• Sick leave
• Health economics
• Proton-pump inhibitor

Informations

• Publié par: biomed
• Publié le: 01 janvier 2010
• Nombre de lectures: 3
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

7.Gross_Umbruchvorlage17.03.1011:09Seite124124EuRoPEanJouRnalofMEDIcalREsEaRcHMarch30,2010
EurJMedRes(2010)15:124-130©I.HolzapfelPublishers2010

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M.Gross
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,u.beckenbauer
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,J.burkowitz
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,H.Walther
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,b.brueggenjuergen
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oIntHeeranlitshtisMcahneagkelimniekntDronMliünlleera,GM,üoncbherehna,cGhienrgm,aGnye,rmany,
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alphacareGmbH,celle,Germany

Abstract
symptoms,includingasthma,chroniccough,and
Background:
Gastro-oesophagealrefluxdisease(
GERD
)laryngitis[5].Esophagealandextra-esophagealsymp-
isacommondisorderwithconsequencesforthepa-tomsareregardedasthereasonsfortheexperienceof
tient’shealth-relatedqualityoflife(HRQol).InGer-pain,lackofvitality,andfeelingsofpoorphysicaland
many,fewdataareavailableontheimpactofGERDmentalhealth[6].GERDsubstantiallyimpairsallas-
onwork-relatedproductivity.pectsofHRQol[6,7].
Aim:
tostudytheimpactofGERDonworkproduc-thewide-rangingeffectsofGERDonhealthand
tivitydespiteprotonpumpinhibitor(PPI)therapyandwell-beingcanhaveconsequencesfortheperfor-
theassociationbetweenproductivityandsymptomdu-manceoftheaffectedindividuals,particularlyatwork
ration,severity,andHRQol.[8].Inseveralstudiesthathaveanalyzedmeasuresof
Methods:
Retrospectivedatafromrandomlyselectedworkproductivity,thelossofproductivityranged
patientswithchronicGERDsymptoms,treatedbyof-from6%to42%amongindividualswithGERD[8].
fice-basedgeneralpractitionersorgeneralinternistsGERDcausessignificantindirectcostsattributableto
withroutineclinicalcare,wereanalyzedtogetherwithreducedproductivityandtimeoffwork[9].aGer-
informationfromself-administeredinstrumentsas-manstudyshowedthat10%oftotaldisease-related
sessingworkproductivity(WPaI–GERD),symptomscostswereindirectcostsarisingfromworkingdays
(RDQ),andHRQol(QolRaD).losttoillness[2].oneanalysisestimatedalossof
Results:
Reducedproductivitywasreportedby152ofgrossdomesticproductof€688million/yeardueto
249patients(61.0%),although89.5%ofthemwereGERD-relatedinabilitytoworkinGermany[10].
treatedwithPPI.thereductioninworkproductivityInGermany,theimpactofGERDnotonlyonthe
was18.5%inallpatientsand30.3%inthosewithre-abilitytowork[10]butalsoonoverallwork-related
ducedproductivity.Patientswithimpairedproductivityproductivityhasbeenstudiedonlyoncewithinanin-
showedasignificantlylowerHRQolandmore-severeternationalcontext[11].theoveralllossinproductivi-
symptomsofrefluxdisease.Inallpatients,themeantywas3.5hours/week[11].However,theresultswere
sickleaveattributabletorefluxsymptomswas0.6difficulttocomparebecauseanon-standardizedin-
hoursintheprevioussevendaysand1.4workdaysinstrumentwasused.
thepreviousthreemonths.theaimofthisstudywastoexploretheextentof
Conclusion:
GERDhasasubstantialimpactonworkGERD-inducedlossofworkproductivity(working
productivityinGermany,eveninpatientsreceivingdayslostandreducedproductivitywhileworking)ina
routineclinicalcareandPPItherapy.Germanprimary-carepatientpopulationwithchronic
refluxsymptoms.theassociationbetweenproductivi-
Keywords:
Gastro-oesophagealreflux;sickleave;tylossfromGERDsymptomsandhealth-related
Medicaleconomics;ProtonPumpInhibitorsqualityoflife(HRQol)wasalsoanalyzed.
I
ntRoDuctIon
M
atERIalsanD
M
EtHoDs
Gastro-oesophagealrefluxdisease(GERD)isacom-s
tuDy
s
ubJEcts
monandcostlychronicdisorder,withconsequences
forthepatient’shealth-relatedqualityoflife(HRQol)InGermany,theinitialmanagementofGERDoccurs
[1-3].theprevalenceofGERDhasbeenestimatedtoinprimarycare,providedbyoffice-basedphysicians.
bebetween10%and20%intheWesternworld[1].Inthisincludesaclinicalevaluation,furtherdiagnostic
Germany,14%oftheadultpopulationreportmoder-procedures,andmedicaltreatment[12].therefore,pa-
aterefluxsymptomsand4%reportseveresymptomstientswithchronicrefluxsymptomswererandomly
[4].besidesesophagealsymptoms,patientssufferselectedfromasampleofprimary-carepatientsofof-
fromchestpainandavarietyofextra-esophagealfice-basedphysicians(generalpractitioners[GPs]and

.7rGso_smUrbcuvhroaleg710..31011:09Seite125March30,2010EuRoPEanJouRnalofMEDIcalREsEaRcH125
generalinternists)intheMunicharea(bothruralandsia[13].thequestionnaireconsistsof25items,which
urbandistricts)insouthernGermany.allphysiciansareorganizedintofivedomains(3–6itemseach):
cooperatedwiththe“HealthManagementonline”or-emotionaldistress,sleepdisturbance,eatinganddrink-
ganization(H-M-oaG)inoberhaching,southerningproblems,physical/socialfunctioning,andvitality.
Germany,whichselectedtheparticipatingphysicians.thedegreeandfrequencyofdistressandthepatients’
seventeenofthe78physicianswhichwereinvitedtofeelingsduringtheprecedingweekareassessedona
participatetookpartinthestudyincluding13GPsseven-pointlikertscale,withahigherscorerepresent-
and4generalinternists.Dataforthisretrospective,inglessfrequencyordistress.althoughthereisnode-
multicenterobservationalstudywerecollectedbe-tailedevaluationofQolRaD,adifferenceofap-
tweenJulyandnovember,2007.proximatelyonepointisconsideredtobeclinicallyrel-
theinclusioncriteriawere:(1)atleast18yearsold;evant[14].aGermantranslationofQolRaDhas
(2)atleastonevisitbecauseofrefluxsymptomsmoreshowngoodpsychometricqualities[15].
thansixmonthsbeforestudyentryandafollow-up
visitforrefluxsymptomsbetweensixandthree
RefluxDiseaseQuestionnaire(RDQ)
monthsbeforestudyentry.thesecriteriawerechosentheoriginalRDQisadiagnosticinstrumentwith12
toincludeonlypatientswithchronicrefluxdisease.questionsthatevaluatethefrequencyandseverityof
GERDwasdiagnosedbythephysiciansaccordingtoburningbehindthesternum,painbehindthesternun,
theInternationalclassificationofDiseases,tenthRe-upperstomachburning,upperstomachpain,acidtaste
vision(IcD10),GermanModification2007,accord-inthemouth,andmovementofmaterialduringthe
ingtothecodesgivenintable1.anupperendoscopyprecedingfourweeks[16].aGermanversionwascre-
recentlyoralongertimeagowasnotmandatory.theatedtoassessthetreatmentresponseforashorterpe-
exclusioncriteriaincludedothersignificantuppergas-riodofoneweekusingsix-pointscalesrangingfrom
trointestinaldisorders(includingZollinger–Ellisonnooccurrencetodaily/severe[17].thisversionhas
syndrome,gastricorduodenalulcer,esophagealstric-beencarefullyvalidatedandadequatevalidity,reliabili-
ture,andahistoryofdysplasiainbarrett’sesophagus).ty,andsensitivityhavebeendemonstrated.Withprin-
thephysiciansidentifiedallpatientsintheirofficeciplecomponentsanalysis,threefactors(regurgitation,
databasewhofulfilledtheinclusioncriteria.anheartburn,anddyspepsia)wereidentified.acombined
anonymizedlistofpatientswastransferredtothescoreforthefactorsregardingGERDsymptoms(re-
studyorganizationwhichrandomlyselectedthepa-gurgitation+heartburn)couldbecalculated.
tients.thepatientswereinvitedinwritingtopartici-
pateinthestudyandtomakeanappointmentwith
WorkProductivityandActivityImpairment
theirphysician.Writteninformedconsentwasob-
Questionnaire(WPAI–GERD)
tainedfromallpatientsbeforestudyentry.thepa-theWPaI–GERDistheGERD-specificvalidated
tientscompletedthequestionnairesintheofficeofversionofageneralhealthmeasurethathasbeen
theirphysician.modifiedforseveralhealthconditions[18].Itwasde-
velopedtoestimatetheimpactofheartburnandacid
Table1.
IcD10GERDdiagnosticcodesidentifyingPatients
regurgitationonproductivityandhasbecomeastan-
withrefluxdisease.
dardtoolfortheevaluationofworkproductivity[8,
19].thequestionnairecontainsthreeopen-ended
codeDiagnosis
questionsabouthoursabsentfromworkforhealth
reasons,hoursabsentfromworkforotherreasons,
k21Gastroesophagealrefluxdisease
andthenumberofhoursworkedduringthelastseven
days.thepatientswereinstructednottoincludethe
k21.0Gastroesophagealrefluxdiseasewithesophagitis-
timespentparticipatinginthestudyastimeabsent
Refluxesophagitis
fromwork.Intwofurtherquestions,patientsratedthe
k21.9Gastroesophagealrefluxdiseasewithoutesophagitis
impactofrefluxsymptomsontheirproductivity(per-
R12Heartburn-Excludesdyspepsia
centagereductioninproductivityatwork).basedon
theWPaI–GERDresults,aworkproductivityscore
(WPs)wascalculated,whichexpressesthelostpro-
I
nstRuMEnts
ductivitybecauseofGERDsymptomsforeachpa-
tientasapercentageoftheirtotalpotentialproductiv-
Dataconcerningresourceuseandtreatmentwithinity.aWPsofzeromeansnoreducedproductivity,a
theobservationperiodovertheprecedingsixmonthsvalueabovezeromeansreducedproductivity.
wasgatheredretrospectivelyfrompatientrecords.to
measurethetreatmentoutcomesandthepatients’
WPs=[(hoursabsentfromwork+percentagereduced
GERD-relateddistress,aquestionnairewascompleted
productivityatworkhoursactuallyworked)/(hoursab-
bytheparticipants,whichincludedstandardizedvali-
sentfromwork+hourslostforotherreasons+hoursac-
datedself-administeredinstrumentstoassesswork
tuallyworked)]100
productivityandevaluatebothsymptomsandHRQol
inassessingtheresponsetotreatment.
Absenteeismfromworkintheprecedingthreemonths
thepatientswereaskedabouttheirabsenteeism
QualityofLifewithRefluxandDyspepsia(QOLRAD)
fromwork(hoursordays)intheprecedingthree
theQolRaDwasdevelopedtoassessHRQolinmonthsresultingfromrefl