Productivity Loss in Severe Asthma: A Systematic Review

OBJECTIVES: Severe asthma (SA) imposes a substantial clinical and economic burden for individuals, health systems and society. This study aims to assess impact of SA on patients’ or caregiver’s productivity.

METHODS: A systematic search was conducted using MEDLINE, Embase, the Cochrane Library, LILACS, CRD and Google to identify systematic reviews with meta-analyses, clinical trials and observational studies reporting productivity losses related to severe asthma. Results were described qualitatively.

RESULTS: Nineteen observational studies were included, with two assessing Brazilian patients (pediatric). Population ranged from 32 to 605,614, most females, over 40 years old. Five studies reported ~40% of patients had asthma exacerbations in the last year. Overall, studies demonstrated higher presenteeism (n=3), work absenteeism (n=9), school absenteeism (n=2), disability (n=3) and indirect costs (n=8) for SA patients comparing to controls. Studies in Brazil showed up to 90% of SA patients were absent from school at least one day per year and 47% experienced job loss or had a family member who lost job because of asthma. Four studies used Work Productivity and Activity Impairment (WPAI) questionnaire and Work Performance Scale (WPS). WPAI results indicated 21.4%-36.5% of work in the previous week had some impairment (absenteeism/presenteeism). Absenteeism and presenteeism were present in 21%-23% of hours worked and 20%-31% of work performed in the previous week. WPS score ranged from 75.4-85.7, according to asthma severity domains assessed (higher values indicating better performance at work). Mean annual indirect costs per patient with SA ranged from BRL 7,104 to BRL 36,067 (1 USD = BRL 5.6417).

CONCLUSIONS: SA was associated with work impairment, presenteeism and absenteeism, in adults and children, demonstrating deep impact on patient’s lives and society. Indirect costs increase with the level of asthma severity or lack of disease control, highlighting the importance of appropriate disease management and control. Funding: GSK (218072).