Rheumatoid arthritis: indirect costs associated to productivity loss under the perspective of employers in Brazil

Abstract

Objective: To estimate indirect costs associated with rheumatoid arthritis (RA) under the perspective of Brazilian employers and to project cost offsets associated to the use of tumor necrosis factor inhibitors (anti-TNFs) therapies, focused on adalimumab, for treatment of RA. Methods: A customizable model of the workplace impacts of alternative RA treatments was calibrated with Brazilian specific parameters based on data from the scientific literature and government sources. The model included employment sector wages to allow for comparisons across industries. Costs of medical leave absenteeism/disability, reduced productivity, job turnover, and work-equipment adaptations were calculated for RA employees treated with adalimumab versus other traditional disease-modifying antirheumatic drugs (DMARDs) and employer costs were compared between groups. Results: In the base case scenario, the annual indirect cost of employees with RA was R$4.439 for employees on adalimumab (23% of wages) versus R$7.959 for employees on traditional DMARDs therapies (42% of wages). The R$3.520 offset reduction in employer costs for RA workers on adalimumab included reduced medical leave (R$700) and job turnover (R$987), and higher productivity (R$1.833). Savings per RA worker on adalimumab ranged from R$2.453 in the waste treatment sector to R$27.516 in the petroleum extraction sector. Conclusions: RA imposes a large financial burden on employers in Brazil. This burden is substantially less for employees treated with adalimumab versus traditional DMARDs as a result of higher productivity, lower turnover, and lower absenteeism. Impacts vary across industries, with high-wage sectors presenting the greatest impacts.