Resolution of Upper Gastrointestinal Symptoms Associated With Chronic Non-Steroidal Anti-Inflammatory Drug Therapy has a Positive Impact on Patient-Reported Productivity Peter Wahlqvist,1 Klas Bergenheim,1 Göran Långström,1 Jørgen Næsdal1
1Clinical Science, AstraZeneca, Mölndal, Sweden
Table 1. Productivity results for all patients at baseline and for responders/non-responders at follow-up after 2 or 4 weeks (4-week data used for non-responders at 2 weeks) CONCLUSION Baseline Follow-up Results from this exploratory study All patients Responders Non-responders Difference indicate that successful treatment of Mean Mean Mean Mean upper gastrointestinal symptoms in p-value§ chronic NSAID users has a significantly positive impact on their ability to work and carry out daily activities. 1. INTRODUCTION
#Hours lost due to reduced productivity while at work = number of hours actually worked multiplied by per cent of reduced
It is estimated that 20–35% of patients using
NSAIDs, including COX-2 selective NSAIDs,
A recent international, placebo-controlled
percentage by which productivity is reduced
while performing regular daily activities other
efficacy of 4 weeks’ esomeprazole treatment in
upper abdominal pain, discomfort or burning)
Quality of Life in Reflux and Dyspepsia
associated with continuous COX-2-selective
QOLRAD is a disease-specific questionnaire
and non-selective NSAID use in a non-ulcer
statistically significant and relatively high
upper GI symptoms on quality of life (QoL)
(range: 0.4–0.6), supporting the validity of
during the previous week, in which 25 items
combine into 5 dimensions: Sleep disturbance,
Furthermore, a relationship was established
To explore the impact of upper GI symptoms,
Food and drink problems, Emotional distress,
between reduced productivity variables and
in chronic NSAID users, on the ability to work
Vitality, and Physical/social functioning.
GI symptoms (GSRS dimensions and upper GI
Gastrointestinal Symptom Rating Scale
symptom diary data), the strongest being withthe GSRS dimension Abdominal pain. 3. METHODS
GSRS is a scale for assessing GI symptomsduring the previous week, in which 15 items
A productivity questionnaire was given to all
Table 2. Change score correlations between baseline
the Swedish patients (n=77) participating in
and 4 weeks (2-week data used when 4-week data were missing); Pearson correlation coefficients
non-responders after 2 or 4 weeks’ treatment
were identified by use of upper GI symptom
productivity, productivity, 4. RESULTS work (n=25) activities (n=57)
diaries (primary measure in clinical study). Responders were defined as having a reduction
Evaluable productivity data were obtained
QOLRAD dimensions
from 61 patients (mean age 54 [range 20–78]
mild symptoms, on a 7-grade Likert scale,
years; 41 responders, 20 non-responders)
of which 27 patients (44%; 14 responders,
Results were calculated for responders and
non-responders irrespective of treatment.
treatment (baseline), patients reported an
Other patient-reported instruments in the
study included the Quality of Life in Reflux
GSRS dimensions
(per patient, per week); a reduction in work
Productivity questionnaire
A Work Productivity and Activity Impairment
(WPAI) questionnaire, previously used and
Upper GI symptoms
validated in patients with gastroesophageal
from work, 12 percentage units for reduced
Abbreviations: GI = gastrointestinal; GSRS = Gastrointestinal
reflux disease,4 was modified to assess the
Symptom Rating Scale; QOLRAD = Quality of Life in Reflux
work productivity and 16 percentage units
impact of upper GI symptoms on productivity
and Dyspepsia. *p<0.05; **p<0.01.
for reduced productivity in activities.
during the previous week. The questionnairecontains three questions relating to work time:
On a weekly basis, therefore, results imply
that treatment success is associated with an
5. REFERENCES
avoidable loss of work productivity of around
1. Langman MJ, et al. JAMA 1999; 282: 1929–33
other reasons; and hours actually worked.
2. Buttgereit F, et al. Am J Med 2001; 110 (Suppl 3A): 13S–9S
There are two questions regarding reduced
0.7 hours are due to absence from work and
3. Yeomans N, et al. Gastroenterology 2003; 124(Suppl 1): A107
4. Wahlqvist P, et al. Value Health 2002; 5: 106–13
productivity: one relates to the percentage by
5. Wiklund I, et al. Eur J Surg 1998; 164(Suppl 583): 41–9
which productivity at work is reduced due to
6. Revicki DA, et al. Qual Life Res 1998; 7: 75–83
Supported by a grant from AstraZeneca R&D, MöIndal, Sweden
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