Productivity loss outcomes and costs among patients with cholangiocarcinoma in the United States: an economic evaluation
Creators: name: Parasuraman, Shreekant
name: Thiel, Ellen
name: Park, Julie
name: Teschemaker, Anna
Publisher: name: Taylor & Francis
Year: 2023
Subjects: subject: Medicine
subject: Ecology
subject: FOS: Biological sciences
subject: Sociology
subject: FOS: Sociology
subject: Immunology
subject: FOS: Clinical medicine
subject: Science Policy

description: Cholangiocarcinoma (CCA) is associated with poor prognosis. Healthcare-related management likely presents a substantial economic burden associated with time away from work in patients with CCA. To assess productivity loss, associated indirect costs, and all-cause healthcare resource utilization and costs owing to workplace absenteeism, short-term disability, and long-term disability in CCA patients with work absence and disability benefits eligibility in the United States. US retrospective claims data from Merative MarketScan Commercial and Health and Productivity Management Databases. Eligible patients were adults with ≥1 non-diagnostic medical claim for CCA in the index period (1 January 2011–31 December 2019) and had ≥6 months of continuous medical and pharmacy benefit enrolment before and ≥1 month of follow-up and full-time employee work absence and disability benefits eligibility after the index date. Outcomes were assessed in patients with CCA, intrahepatic CCA (iCCA), and extrahepatic CCA (eCCA) in absenteeism, short-term disability, and long-term disability cohorts (measured per patient per month [PPPM] for a month of 21 workdays), with costs standardized to 2019 USD. One thousand and sixty-five patients with CCA were included (iCCA: <i>n</i> = 624 [58.6%]; eCCA: <i>n</i> = 380 [35.7%]). The mean age was 51.9–53.9 years across cohorts. In patients with iCCA and eCCA, respectively, the number of mean all-cause days absent PPPM for illness was 6.0 and 4.3, and 12.9 and 6.6% had ≥1 CCA-related short-term disability claim. Median indirect costs PPPM owing to absenteeism, short-term disability, and long-term disability, respectively, in patients with iCCA were $622, $635, and $690, and $304, $589, and $465 in patients with eCCA. Patients with iCCA <i>vs.</i> eCCA had higher inpatient, outpatient medical, outpatient pharmacy, and all-cause healthcare costs PPPM. Patients with CCA had high productivity losses, indirect costs, and medical costs. Outpatient services costs contributed greatly to the higher healthcare expenditure observed in patients with iCCA <i>vs.</i> eCCA. Cholangiocarcinoma (CCA) changes patients’ health, lives, finances, and work. We wanted to understand the effect of CCA on work, costs of lost workdays, and costs of healthcare for patients in the US. We looked at health insurance claims for 1,065 adults which included payments requested to insurance providers for covered healthcare from 2011 to 2019. We grouped people in three ways. The “absence group” included 107 people whose work absences we could track. The “short-term leave” (STL) group included 617 people whose jobs allowed short-term medical leave benefits. The “long-term leave” (LTL) group included 549 people whose jobs allowed long-term medical leave benefits. People could belong to more than one group, i.e. a person who had an absence could also take STL or LTL. About two thirds of the employees with CCA in the absence group missed at least 1 day of work because of illness and lost more than 5 workdays per month on average. Work lost for all absences generally costs employers almost $1000 per month. About half of the STL group took short-term leaves. On average, they lost 6–7 workdays per month, costing about $860. About one-tenth of the LTL group took long-term leaves. On average, they lost just over 6 workdays per month, costing about $800. Average total healthcare costs for all groups were about $10,300–$11,200 per month. Overall, people with CCA inside the liver missed more days from work because of illness and had higher total healthcare costs compared to those with CCA outside the liver.