Background/Purpose: Non-radiographic axial spondyloarthritis (nr-axSpA) is a burdensome disease to both the patient and the healthcare system, as previous research has indicated. However, the societal burden is less well understood, particularly from the employer perspective. The aim of this analysis was to quantify the burden nr-axSpA patients have on employers.

Methods: Data were taken from the 2014 nr-axSpA Disease Specific Programme a cross-sectional, multi-national survey of nr-axSpA patients and their rheumatologists conducted in France, Germany, Italy, Spain and the UK. Rheumatologists completed patient record forms containing patient demographics and treatment history. These patients completed patient self-completion (PSC) forms containing the Work Productivity and Activity Impairment questionnaire and annual income. Patients who were biologic treatment naïve, yet were considered eligible for biologic treatment by the physician, were compared to patients who had been receiving their current biologic treatment for 6 months or more. Questions regarding income had banded responses and so the midpoint was used in all calculations. Observations were weighted to ensure findings were more representative of the patient population. The weight was applied when calculating all percentages, means and SDs. The human capital method was applied in order to calculate the burden of productivity-loss.  

Results: A total of 310 patients were included in the analysis (mean age 42.5±11.8 [SD], 74.8% male), with 123 biologic-naïve patients and 187 patients currently receiving a biologic. Only 76 patients completed a PSC in total. Over half (59.8%) of biologic-naïve patients were employed compared to 78.8% of the biologic-treated patients. The most frequently stated reason for having not yet prescribed biologic treatment in a candidate was “Very recent diagnosis” (32.5%). Biologic-naïve patients had greater overall work impairment compared to biologic-treated patients (means: 37.1% vs. 18.8%; diff.=18.4%). The mean annual income for the biologic-naïve cohort was 30,171.83€ and the mean duration between diagnosis and first biologic to be prescribed was 17.4 months for the biologic-treated cohort. Therefore, productivity-loss associated with biologic-naïve patients compared to biologic-treated patients equates to 10,834.92€ from the employer perspective, per-patient. 

Conclusion: The burden on the economy due to productivity-loss per nr-axSpA patient is substantial. This burden is avoidable to some extent where patients are eligible for biologic treatment. Moreover, biologic treatment was withheld in a third of eligible patients due to a recent diagnosis, suggesting earlier initiation of biologic treatment could be considered.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-burden-of-non-radiographic-axial-spondyloarthritis-from-the-employer-perspective-a-real-world-european-study/