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Background: The personal economic impact of bariatric surgery is not well-described. Objectives: To examine earnings and work loss from 5 years before to 5 years after bariatric surgery compared with the general population. Setting: Nationwide matched cohort study in the Swedish health care system. Methods: Patients undergoing primary bariatric surgery (n = 15,828) and an equal number of comparators from the Swedish general population were identified and matched on age, sex, place of residence, and educational level. Annual taxable earnings (primary outcome) and annual work loss (secondary outcome combining months with sick leave and disability pension) were retrieved from Statistics Sweden. Participants were included in the analysis until the year of study end, emigration or death. Results: From 5 years before to 5 years after bariatric surgery, earnings increased for patients overall and in subgroups defined by education level and sex, while work loss remained relatively constant. Bariatric patients and matched comparators from the general population increased their earnings in a near parallel fashion, from 5 years before (mean difference -$3,489 [95%CI -3,918 to -3,060]) to 5 years after surgery (-$4,164 [-4,709 to -3,619]). Work loss was relatively stable within both groups but with large absolute differences both at 5 years before (1.09 months, [95%CI 1.01 to 1.17]) and 5 years after surgery (1.25 months, [1.11 to 1.40]). Conclusions: Five years after treatment, bariatric surgery had not reduced the gap in earnings and work loss between surgery patients and matched comparators from the general population. [ABSTRACT FROM AUTHOR]

Background: Sick-leave is an important source of productivity losses to society. The objective of this study was to investigate the association between body mass index (BMI) status in young adulthood and future sick-leave. Methods: A nation-wide cohort of 43 989 Swedish men (18.7 ± 0.5 years) performing military conscription tests in 1969–70 were followed between 1986 and 2005 regarding sick-leave. BMI was used to define underweight (<18.5), normal weight (18.5–24.9), overweight (25.0–29.9) and obesity (&geq;30.0). Relative risks of sick-leave were estimated with Cox proportional hazards models adjusted for smoking, socio-economic index and muscular strength, using normal weight as the reference. Results: During 803 684 person-years of follow-up, 488 570 sick-leave episodes were recorded. On average, one short-term (&leq;7 days) episode occurred every eight person-months, one intermediate-term (8–30 days) every five person-years and one long-term (>30 days) episode every 15 person-years. Overweight was associated with 20% and obesity with >30% risk elevation for episodes ranging from 8 to 30 days [hazard ratio (HR) 1.20; 95% CI 1.15–1.24 and HR 1.35; 95% CI 1.24–1.47, respectively] as well as for episodes >30 days (HR 1.19; 95% CI 1.15–1.23 and HR 1.34; 95% CI 1.24–1.47, respectively) compared to normal weight. Obesity was also associated with an increased risk of sick-leave episodes &leq;7 days (HR 1.13; 95% CI 1.09–1.16), but the corresponding risk increase for overweight was very small (HR 1.02; 95% CI 1.00–1.03). Underweight showed increased risk only for short-term episodes (HR 1.05; 95% CI 1.04–1.07). Discussion: Overweight and obesity are associated with increased risk for sick-leave compared to normal weight, especially for sick-leave episodes of longer duration. [ABSTRACT FROM PUBLISHER]

Summary: Background: Inflammatory bowel disease has been linked to increasing healthcare costs, but longitudinal data on other societal costs are scarce. Aim: To assess costs, including productivity losses, in patients with prevalent Crohn's disease (CD) or ulcerative colitis (UC) in Sweden between 2007 and 2020. Methods: We linked data from national registers on all patients with CD or UC and a matched (sex, birthyear, healthcare region and education) reference population. We assessed mean costs/year in Euros, inflation‐adjusted to 2020, for hospitalisations, out‐patient visits, medications, sick leave and disability pension. We defined excess costs as the mean difference between patients and matched comparators. Results: Between 2007 and 2020, absolute mean annual societal costs in working‐age (18–64 years) individuals decreased by 17% in CD (−24% in the comparators) and by 20% in UC (−27% in comparators), due to decreasing costs from sick leave and disability, a consequence of stricter sick leave regulations. Excess costs in 2007 were dominated by productivity losses. In 2020, excess costs were mostly healthcare costs. Absolute and excess costs increased in paediatric and elderly patients. Overall, costs for TNF inhibitors/targeted therapies increased by 274% in CD and 638% in UC, and the proportion treated increased from 5% to 26% in CD, and from 1% to 10% in UC. Conclusion: Between 2007 and 2020, excess costs shifted from productivity losses to direct healthcare costs; that is, the patients' compensation for sickness absence decreased, while society increased its spending on medications. Medication costs were driven both by expanding use of TNF inhibitors and by high costs for newer targeted therapies. [ABSTRACT FROM AUTHOR]

Summary: Background: There are limited data on population‐wide assessment of cost in Crohn's disease (CD) and ulcerative colitis (UC). Aim: To estimate the societal cost of actively treated CD and UC in Sweden. Methods: We identified 10 117 prevalent CD and 19 762 prevalent UC patients, aged ≥18 years on 1 January 2014 and 4028 adult incident CD cases and 8659 adult incident UC cases (2010‐2013) from Swedish Patient Register. Each case was matched to five population comparators. Healthcare costs were calculated from medications, outpatient visits, hospitalisations and surgery. Cost of productivity losses was derived from disability pension and sick leave. Results: The mean annual societal costs per working‐age patient (18‐64 years) with CD and UC were $22 813 (vs $7533 per comparator) and $14 136 (vs $7351 per comparator), respectively. In patients aged ≥65 years, the mean annual costs of CD and UC were $9726 and $8072 vs $3875 and $4016 per comparator, respectively. The majority of cost for both CD (56%) and UC (59%) patients originated from productivity losses. Higher societal cost of working‐age CD patients as compared to UC patients was related to greater utilisation of anti‐TNF (22.2% vs 7.4%) and increased annual disability pension (44 days vs 25 days). Among incident CD and UC patients, the mean total cost over the first year per patient was over three times higher than comparators. Conclusion: In Sweden, the societal cost of incident and prevalent CD and UC patients was consistently two to three times higher than the general population. [ABSTRACT FROM AUTHOR]

Objective. To compare work-loss in RA patients starting their first biologic with high vs moderate disease activity. Methods. We identified all RA patients aged 20-63 years in the Swedish Biologics Register who started their first biologic 2007-09 with high disease activity (DAS28 >5.1; n = 868) or moderate disease activity (DAS28 3.2-5.1; n = 854). Work days lost, defined as sick leave and disability pension days from the Swedish Social Insurance Agency, were assessed over 5 years after first bio-start. We estimated be-tween-group mean differences adjusted for age, sex, calendar year, education level, disease duration, comorbidities and work-loss the month before bio-start. Results. During 5 years after anti-TNF start, mean monthly work days lost declined from 16.0 to 9.2 (42%; P< 0.001) in patients with high disease activity at baseline and from 12.0 to 7.2 (40%; P< 0.001) in patients with moderate disease activity, with no between-group difference (adjusted mean difference 0.81; 95% CI-0.44, 2.05). Accumulated 5-year work-loss was, however, higher in the high activity group (724 vs 548 days; adjusted mean difference 70; 95% CI 20, 120), but after stratification on baseline disability pension status, no differences in accumulated work-loss were detected. Conclusion. Substantial work-loss was seen in both patients with high and patients with moderate disease activity at anti-TNF start, with a 5-year decline in mean monthly work days lost by ~40% in both groups and no between-group difference. Accumulated work-loss over 5 years was higher in the high-activity group, which may be explained by differences in baseline disability pension status. [ABSTRACT FROM AUTHOR]

Purpose.To investigate if testicular cancer survivors (TCSs) have a higher incidence of work loss compared with the population, accounting for stage, treatment and relapse. Material and methods.A cohort of 2146 Swedish TCSs diagnosed 1995–2007 (seminoma n = 926, non-seminoma n = 1220) was identified in the SWENOTECA (Swedish-Norwegian Testicular Cancer Group) register, and matched 1:4 to population comparators. Prospectively recorded work loss data (both before and after diagnosis) were obtained from national registers through September 2013. Adjusted relative risks (RR) and 95% confidence intervals (CI) of sick leave and/or disability pension were calculated annually and overall with Poisson- and Cox regression, censoring at relapse. The mean number of annual work days lost was also estimated. Results.TCSs were at a modestly increased annual risk of work loss up to the third year of follow-up (RR3rd year1.25, 95% CI 1.08, 1.43), attributed to a more pronounced risk among extensively treated patients (4 chemotherapy courses: RR3rd year1.60, 95% CI 1.19, 2.15; > 4 courses: RR3rd year3.70, 95% CI 2.25, 6.11). Patients on surveillance or limited treatment (radiotherapy, 1–3 chemotherapy courses) did not have an increased risk of work loss beyond the first year. TCSs receiving > 4 chemotherapy courses had higher mean number of annual days of work loss up to the 10th year post-diagnosis, and a five-fold risk of disability pension (RR 5.16, 95% CI 2.00, 10.3). Conclusion.Extensively treated TCSs, but not those on surveillance or limited treatment, are at increased risk of work loss long-term, not explained by relapse. These patients may benefit from early rehabilitation initiatives. [ABSTRACT FROM PUBLISHER]