Improvements in Work Productivity Loss and Associated Cost Reductions with Ustekinumab and Adalimumab in Biologic-Naive Patients with Moderately-to-Severely Active Crohn's Disease: Results From the SEAVUE Study

Introduction: Work productivity loss (WPL) results in indirect costs that contribute to the overall economic burden of Crohn’s disease (CD). Effective treatments would ideally reduce WPL among patients with CD. This analysis used data from the Phase IIIb SEAVUE trial—the first head-to-head comparison of two biologics in CD—to analyze the impact of ustekinumab (UST) and adalimumab (ADA) on WPL and associated costs in biologic-naïve patients with moderately-to-severely active CD who previously failed or were intolerant to conventional therapy. Methods: In the SEAVUE study, patients were randomized to receive either UST (N=191) or ADA (N=195) for 52 weeks to compare the safety and efficacy of the two biologics. One of the assessments included in this study was the Work Productivity and Activity Impairment Questionnaire in CD (WPAI-CD), which evaluates absenteeism (absence from work), presenteeism (impairment while working) (the two components of WPL), overall work impairment, and activity impairment outside of work. In this analysis, changes from baseline to Week 52 in WPAI-CD (expressed as percent impairment) were determined as reported for each treatment group, and WPL-related costs were calculated using a mean annual wage of $57,900 USD (U.S. Census Bureau 2019). Results: Mean percent impairment for absenteeism was 19.8% and 20.7% at baseline in the UST and ADA groups, respectively. From baseline to Week 52, mean absenteeism decreased by 13.8 (UST) and 9.9 (ADA) percentage points. From baseline to Week 52, mean presenteeism decreased by 32.2 percentage points in the UST group (from 52.9% impairment at baseline) and by 24.3 percentage points in the ADA group (from 48.0% impairment at baseline). Improvements in these outcomes were observed as early as Week 8. Changes from baseline to Week 52 in work productivity/activity impairment are reported in Table 1. Decreases in absenteeism from baseline to Week 52 were associated with cost reductions of $7,990 in the UST group and $5,732 in the ADA group. Cost reductions associated with improvements in presenteeism from baseline to Week 52 were $13,298 in the UST group and $9,799 in the ADA group. Overall cost reductions associated with improvements in WPL (absenteeism and presenteeism) from baseline to Week 52 were $21,289 with UST and $15,531 with ADA (Figure 1). Conclusion: These findings show that treatment with UST or ADA improves WPL among biologic-naïve patients with CD, resulting in reduced indirect costs and decreased economic burden of CD.Table 1Figure 1.: Kaplan-Meier survival analysis of time to composite POR by index Rutgeerts' score.