The 1-Year Economic Impact of Work Productivity Loss Following Severe Lower Extremity Trauma.
Journal
The Journal of bone and joint surgery. American volume
ISSN: 1535-1386
Titre abrégé: J Bone Joint Surg Am
Pays: United States
ID NLM: 0014030
Informations de publication
Date de publication:
06 Apr 2022
06 Apr 2022
Historique:
medline:
29
1
2022
pubmed:
29
1
2022
entrez:
28
1
2022
Statut:
ppublish
Résumé
Severe lower extremity trauma among working-age adults is highly consequential for returning to work; however, the economic impact attributed to injury has not been fully quantified. The purpose of this study was to examine work and productivity loss during the year following lower extremity trauma and to calculate the economic losses associated with lost employment, lost work time (absenteeism), and productivity loss while at work (presenteeism). This is an analysis of data collected prospectively across 3 multicenter studies of lower extremity trauma outcomes in the United States. Data were used to construct a Markov model that accumulated hours lost over time due to lost employment, absenteeism, and presenteeism among patients from 18 to 64 years old who were working prior to their injury. Average U.S. wages were used to calculate economic loss overall and by sociodemographic and injury subgroups. Of 857 patients working prior to injury, 47.2% had returned to work at 1 year. The average number of productive hours of work lost was 1,758.8/person, representing 84.6% of expected annual productive hours. Of the hours lost, 1,542.3 (87.7%) were due to working no hours or lost employment, 71.1 (4.0%) were due to missed hours after having returned, and 145.4 (8.3%) were due to decreased productivity while working. The 1-year economic loss due to injury totaled $64,427/patient (95% confidence interval [CI], $63,183 to $65,680). Of the 1,758.8 lost hours, approximately 88% were due to not being employed (working zero hours), 4% were due to absenteeism, and 8% were due to presenteeism. Total productivity loss was higher among older adults (≥40 years), men, those with a physically demanding job, and the most severe injuries (i.e., those leading to amputation as well as Gustilo type-IIIB tibial fractures and type-III pilon/ankle fractures). Patients with severe lower extremity trauma carry a substantial economic burden. The costs of lost productivity should be considered when evaluating outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Severe lower extremity trauma among working-age adults is highly consequential for returning to work; however, the economic impact attributed to injury has not been fully quantified. The purpose of this study was to examine work and productivity loss during the year following lower extremity trauma and to calculate the economic losses associated with lost employment, lost work time (absenteeism), and productivity loss while at work (presenteeism).
METHODS
METHODS
This is an analysis of data collected prospectively across 3 multicenter studies of lower extremity trauma outcomes in the United States. Data were used to construct a Markov model that accumulated hours lost over time due to lost employment, absenteeism, and presenteeism among patients from 18 to 64 years old who were working prior to their injury. Average U.S. wages were used to calculate economic loss overall and by sociodemographic and injury subgroups.
RESULTS
RESULTS
Of 857 patients working prior to injury, 47.2% had returned to work at 1 year. The average number of productive hours of work lost was 1,758.8/person, representing 84.6% of expected annual productive hours. Of the hours lost, 1,542.3 (87.7%) were due to working no hours or lost employment, 71.1 (4.0%) were due to missed hours after having returned, and 145.4 (8.3%) were due to decreased productivity while working. The 1-year economic loss due to injury totaled $64,427/patient (95% confidence interval [CI], $63,183 to $65,680). Of the 1,758.8 lost hours, approximately 88% were due to not being employed (working zero hours), 4% were due to absenteeism, and 8% were due to presenteeism. Total productivity loss was higher among older adults (≥40 years), men, those with a physically demanding job, and the most severe injuries (i.e., those leading to amputation as well as Gustilo type-IIIB tibial fractures and type-III pilon/ankle fractures).
CONCLUSIONS
CONCLUSIONS
Patients with severe lower extremity trauma carry a substantial economic burden. The costs of lost productivity should be considered when evaluating outcomes.
Identifiants
pubmed: 35089905
doi: 10.2106/JBJS.21.00632
pii: 00004623-990000000-00444
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
586-593Investigateurs
Gregory T Altman
(GT)
Christopher M McAndrew
(CM)
Rachel M Reilly
(RM)
Brian H Mullis
(BH)
Hassan R Mir
(HR)
Anjan R Shah
(AR)
William M Reisman
(WM)
Benjamin C Taylor
(BC)
Andrew H Schmidt
(AH)
Todd O McKinley
(TO)
Anthony Sorkin
(A)
Walter W Virkus
(WW)
Greg E Gaski
(GE)
Sanjit R Konda
(SR)
Heather A Vallier
(HA)
H Michael Frisch
(HM)
Robert G Sheu
(RG)
James E Toledano
(JE)
Lisa K Cannada
(LK)
Joshua Langford
(J)
Gregory A Zych
(GA)
James J Hutson
(JJ)
Patrick M Osborn
(PM)
Clay A Spitler
(CA)
Theodore Miclau
(T)
Jason M Wilken
(JM)
Patrick F Bergin
(PF)
David Teague
(D)
Gele B Moloney
(GB)
Ashoke K Sathy
(AK)
William Obremskey
(W)
Eben A Carroll
(EA)
Benjamin K Potter
(BK)
Anthony R Carlini
(AR)
Maningbe Keita
(M)
Jason Luly
(J)
Informations de copyright
Copyright © 2022 by The Journal of Bone and Joint Surgery, Incorporated.
Déclaration de conflit d'intérêts
Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article ( http://links.lww.com/JBJS/G910 ).
Références
Segui-Gomez M, MacKenzie EJ. Measuring the public health impact of injuries. Epidemiol Rev. 2003;25(1):3-19.
Leigh JP. Economic burden of occupational injury and illness in the United States. Milbank Q. 2011 Dec;89(4):728-72.
O’Hara NN, Isaac M, Slobogean GP, Klazinga NS. The socioeconomic impact of orthopaedic trauma: A systematic review and meta-analysis. PLoS One. 2020 Jan 15;15(1):e0227907.
Corso P, Finkelstein E, Miller T, Fiebelkorn I, Zaloshnja E. Incidence and lifetime costs of injuries in the United States. Inj Prev. 2006 Aug;12(4):212-8.
MacKenzie EJ, Bosse MJ. Factors influencing outcome following limb-threatening lower limb trauma: lessons learned from the Lower Extremity Assessment Project (LEAP). J Am Acad Orthop Surg. 2006;14(10 Spec No.):S205-10.
MacKenzie EJ, Bosse MJ, Kellam JF, Pollak AN, Webb LX, Swiontkowski MF, Smith DG, Sanders RW, Jones AL, Starr AJ, McAndrew MP, Patterson BM, Burgess AR, Travison T, Castillo RC. Early predictors of long-term work disability after major limb trauma. J Trauma. 2006 Sep;61(3):688-94.
MacKenzie EJ, Morris JA Jr, Jurkovich GJ, Yasui Y, Cushing BM, Burgess AR, DeLateur BJ, McAndrew MP, Swiontkowski MF. Return to work following injury: the role of economic, social, and job-related factors. Am J Public Health. 1998 Nov;88(11):1630-7.
Bosse MJ, Teague D, Reider L, Gary JL, Morshed S, Seymour RB, Toledano J, Cannada LK, Steverson B, Scharfstein DO, Luly J, MacKenzie EJ; METRC. Outcomes After Severe Distal Tibia, Ankle, and/or Foot Trauma: Comparison of Limb Salvage Versus Transtibial Amputation (OUTLET). J Orthop Trauma. 2017 Apr;31(Suppl 1):S48-55.
Pollak AN, McCarthy ML, Bess RS, Agel J, Swiontkowski MF. Outcomes after treatment of high-energy tibial plafond fractures. J Bone Joint Surg Am. 2003 Oct;85(10):1893-900.
Sluys KP, Shults J, Richmond TS. Health related quality of life and return to work after minor extremity injuries: A longitudinal study comparing upper versus lower extremity injuries. Injury. 2016 Apr;47(4):824-31.
Gabbe BJ, Simpson PM, Harrison JE, Lyons RA, Ameratunga S, Ponsford J, Fitzgerald M, Judson R, Collie A, Cameron PA. Return to Work and Functional Outcomes After Major Trauma: Who Recovers, When, and How Well? Ann Surg. 2016 Apr;263(4):623-32.
Ekegren CL, Edwards ER, Oppy A, Liew S, Page R, de Steiger R, Cameron PA, Bucknill A, Hau R, Gabbe BJ. Twelve-month work-related outcomes following hip fracture in patients under 65 years of age. Injury. 2017 Mar;48(3):701-7.
Hebert JS, Ashworth NL. Predictors of return to work following traumatic work-related lower extremity amputation. Disabil Rehabil. 2006 May 30;28(10):613-8.
Liljas B. How to calculate indirect costs in economic evaluations. Pharmacoeconomics. 1998 Jan;13(1 Pt 1):1-7.
Jeong I, Park JB, Kim HR, Yoon JH, Won JU, Roh J. Impacts of return-to-work type and period on job retention in workers with occupational injuries and diseases. J Korean Med Sci. 2018 Jan 1;33(1):e2.
Krause N, Dasinger LK, Neuhauser F. Modified work and return to work: a review of the literature. J Occup Rehabil. 1998;8(2):113-39.
Butcher JL, MacKenzie EJ, Cushing B, Jurkovich G, Morris J, Burgess A, McAndrew M, Swiontkowski M. Long-term outcomes after lower extremity trauma. J Trauma. 1996 Jul;41(1):4-9.
Kendrick D, Vinogradova Y, Coupland C, Christie N, Lyons RA, Towner EL; UK Burden of Injuries Study Group. Getting back to work after injury: the UK Burden of Injury multicentre longitudinal study. BMC Public Health. 2012 Aug 1;12(1):584.
Jurkovich G, Mock C, MacKenzie E, Burgess A, Cushing B, deLateur B, McAndrew M, Morris J, Swiontkowski M. The Sickness Impact Profile as a tool to evaluate functional outcome in trauma patients. J Trauma. 1995 Oct;39(4):625-31.
Murgatroyd DF, Harris IA, Tran Y, Cameron ID, Murgatroyd D. Predictors of return to work following motor vehicle related orthopaedic trauma. BMC Musculoskelet Disord. 2016 Apr 19;17(1):171.
Bosse MJ, Morshed S, Reider L, Ertl W, Toledano J, Firoozabadi R, Seymour RB, Carroll E, Scharfstein DO, Steverson B, MacKenzie EJ; METRC. Transtibial Amputation Outcomes Study (TAOS): Comparing Transtibial Amputation with and without a Tibiofibular Synostosis (Ertl) Procedure. J Orthop Trauma. 2017 Apr;31(Suppl 1):S63-9.
OʼToole RV, Gary JL, Reider L, Bosse MJ, Gordon WT, Hutson J, Quinnan SM, Castillo RC, Scharfstein DO, MacKenzie EJ; METRC. A prospective randomized trial to assess fixation strategies for severe open tibia fractures: modern ring external fixators versus internal fixation (FIXIT Study). J Orthop Trauma. 2017 Apr;31 Suppl 1:S10-7. Erratum in: J Orthop Trauma. 2017 Sep;31(9):e307. Erratum in: J Orthop Trauma. 2018 May;32(5):e197.
Kim PH, Leopold SS. Gustilo-Anderson classification. In brief: Gustilo-Anderson classification [corrected]. Clin Orthop Relat Res. 2012 Nov;470(11):3270-4. Epub 2012 May 9. Erratum in: Clin Orthop Relat Res. 2012 Dec;470(12):3624. Erratum in: Clin Orthop Relat Res. 2019 Oct;477(10):2388.
Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and dislocation classification compendium—2018. J Orthop Trauma. 2018 Jan;32(Suppl 1):S1-170.
NIOSH (2021). NIOSH Industry and Occupation Computerized Coding System (NIOCCS). U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, Division of Field Studies & Engineering, Health Informatics Branch. Accessed July 2021. https://csams.cdc.gov/nioccs/SingleCrosswalk.aspx
Reilly MC. Development of the Work Productivity and Activity Impairment (WPAI) Questionnaire. Margaret Reilly; 2008. http://www.reillyassociates.net/wpai_general.html
Varin C, Czado C. A mixed autoregressive probit model for ordinal longitudinal data. Biostatistics. 2010 Jan;11(1):127-38.
Pike J, Grosse SD. Friction cost estimates of productivity costs in cost-of-illness studies in comparison with human capital estimates: a review. Appl Health Econ Health Policy. 2018 Dec;16(6):765-78.
Weisbrod BA. The valuation of human capital. J Polit Econ. 1961 Oct;69(5):425-36.
Basu A. Estimating Costs and Valuations of Non-Health Benefits in Cost-Effectiveness Analysis. In: Neumann PJ, Sanders GD, Russell LB, Siegel JE, Ganiats TG, editors. Cost-effectiveness in health and medicine. 2nd ed. Oxford University Press; 2016. p 201-36.
U.S. Bureau of Labor Statistics, U.S. Department of Labor. News Release. Employer Costs for Employee Compensation – September 2018. Accessed December 2018. https://www.bls.gov/news.release/archives/ecec_12142018.pdf
U.S. Bureau of Labor Statistics, U.S. Department of Labor. Occupational Employment and Wage Estimates. OEWS MB3 Estimates. May 2018. Accessed 2021 Jul 6. https://www.bls.gov/oes/oes-mb3-methods.htm
Filipovic-Pierucci A, Zarca K, Durand-Zaleski I. Markov Models for Health Economic Evaluation Modelling in R with the Heemod Package. Value in Health. 2016 Nov 1;19(7):A369. https://www.valueinhealthjournal.com/article/S1098-3015(16)31500-5/fulltext
O’Hara NN, Slobogean GP, Klazinga NS, Kringos DS. Analysis of Patient Income in the 5 Years Following a Fracture Treated Surgically. JAMA Netw Open. 2021 Feb 1;4(2):e2034898.
Nicholson S, Pauly MV, Polsky D, Sharda C, Szrek H, Berger ML. Measuring the effects of work loss on productivity with team production. Health Econ. 2006 Feb;15(2):111-23.