Quality of life, work productivity impairment and healthcare resources in inflammatory bowel diseases in Brazil

Abstract

BACKGROUNDInflammatory bowel diseases (IBD) have been associated with a low quality of life (QoL) and a negative impact on work productivity compared to the general population. Information about disease control, patient-reported outcomes (PROs), treatment patterns and use of healthcare resources is relevant to optimizing IBD management.AIMTo describe QoL and work productivity and activity impairment (WPAI), treatment patterns and use of healthcare resources among IBD patients in Brazil.METHODSA multicenter cross-sectional study included adult outpatients who were previously diagnosed with moderate to severe Crohn’s disease (CD) or ulcerative colitis (UC). At enrolment, active CD and UC were defined as having a Harvey Bradshaw Index ≥ 8 or a CD Activity Index ≥ 220 or calprotectin > 200 µg/g or previous colonoscopy results suggestive of inadequate control (per investigator criteria) and a 9-point partial Mayo score ≥ 5, respectively. The PRO assessment included the QoL questionnaires SF-36 and EQ-5D-5L, the Inflammatory Bowel Disease Questionnaire (IBDQ), and the WPAI questionnaire. Information about healthcare resources and treatment during the previous 3 years was collected from medical records. Chi-square, Fisher’s exact and Student’s t-/Mann-Whitney U tests were used to compare PROs, treatment patterns and the use of healthcare resources by disease activity (α = 0.05).RESULTSOf the 407 patients in this study (CD/UC: 64.9%/35.1%, mean age 42.9/45.9 years, 54.2%/56.6% female, 38.3%/37.1% employed), 44.7%/25.2% presented moderate-to-severe CD/UC activity, respectively, at baseline. Expressed in median values for CD/UC, respectively, the SF-36 physical component was 46.6/44.7 and the mental component was 45.2/44.2, the EQ-visual analog scale score was 80.0/70.0, and the IBDQ overall score was 164.0/165.0. Moderate to severe activity, female gender, being unemployed, a lower educational level and lower income were associated with lower QoL (P < 0.05). Median work productivity impairment was 20% and 5% for CD and UC patients, respectively, and activity impairment was 30%, the latter being higher among patients with moderate to severe disease activity compared to patients with mild or no disease activity (75.0% vs 10.0%, P < 0.001). For CD/UC patients, respectively, 25.4%/2.8% had at least one surgery, 38.3%/19.6% were hospitalized, and 70.7%/77.6% changed IBD treatment at least once during the last 3 years. The most common treatments at baseline were biologics (75.3%) and immunosuppressants (70.9%) for CD patients and 5-ASA compounds (77.5%) for UC patients.CONCLUSIONModerate to severe IBD activity, especially among CD patients, is associated with a substantial impact on QoL, work productivity impairment and an increased number of IBD surgeries and hospitalizations in Brazil.

The Reality of Patient-Reported Outcomes of Health-Related Quality of Life in an Italian Cohort of Patients with Inflammatory Bowel Disease: Results from a Cross-Sectional Study

“…Several studies have shown that IBD strongly impacts work productivity [21,47]. Patients with IBD, significantly younger than those suffering from other chronic diseases, experience an unpleasant condition of work disability, with an increase in unemployment and sick leave and a consequent high socio-economic impact [48]. Social life was negatively influenced by the disease in 74% of the patients in our series and this agrees perfectly with current data showing that up to 75% of IBD patients claimed symptoms which interfere with their ability to enjoy leisure activities [47].…”

COVID-19 quarantine measures are associated with negative social impacts and compromised follow-up care in patients with inflammatory bowel disease in Brazil

“…Active IBD, especially among CD patients, is associated with a substantial impact on quality of life [ 32 , 33 ]. Curiously, our findings did not differ according to diagnosis (UC or CD) or disease status (active or remission), leading us to believe that the pandemic and its containment measures had an early and negative impact on patients regardless of their IBD phenotype.…”

Living with Ulcerative Colitis Study (LUCY) in England: a retrospective study evaluating healthcare resource utilisation and direct healthcare costs of postoperative care in ulcerative colitis

“…15 International studies reported colectomies in 7%-10% of patients with UC, with decreasing colectomy rates over recent years. [16][17][18] Active UC is associated with reduced health-related quality of life (HRQoL) and productivity, [19][20][21][22][23][24] frequent visits to accident and emergency departments (A&E), hospital stays and healthcare costs, [24][25][26] with greater costs with increasing frequency of relapse. 27 Although colectomy may be life-saving, it was recommended not to be considered a cure for UC.…”