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INDIRECT COSTS


INTRODUCTION


Indirect costs are costs that are borne by people and by society, rather than the health care system. Typically, the largest contribution to indirect cost is productivity losses, or work absences – both short-term (sick leave) and long-term (disability leave and/or early retirement). For some diseases, premature death is an important cause of productivity loss. In addition, some people may never enter the work force, or may work part-time hours, for reasons related to health. Also, caregivers (including parents) may have to take time off from work. Economists classify productivity losses as costs that are borne by society in general. Other costs are borne by the individual personally – out-of-pocket expenses such as, home aids and modifications, formal care (housekeeping, daycare), travel for medical appointments, nutritional products, and complementary and alternative medicines.


Most people living with IBD have had the disease for most of their adult lives. People with milder disease may experience some periods of poorer health and long periods of relatively normal health. This may allow them to be in regular employment, but with some absences for sick leave and/or medical appointments. People with more severe disease may have to reduce their hours, change their type of employment, or withdraw from work altogether.


Living with IBD can influence employment choices. Easy access to a bathroom may restrict the types of jobs an individual can perform, such as production line work, outdoor work or jobs with frequent travel, with a trend to select sedentary occupations.78,80


People with IBD worry that their disease may affect their job and career, including having limited choice to remain in a particular job because of the health benefit coverage of expensive drugs. A German study found that 47% of people with CD thought their careers were affected by IBD, as did 39% of people with UC.81


CD felt that their disease had limited their employment prospects and had either prevented them from seeking promotion or had actually prevented promotion.82


broad impact, with 11% of spouses reporting that IBD had compromised their professional careers.83


EDUCATION IMPACT


IBD is often diagnosed in childhood, adolescence or early adulthood. This can impact educational attainment as well as the selection of a career. Education can be affected by temporary absences from school and difficulty with studying or sitting for exams, as well as lack of understanding and discrimination from teachers.82,84


Overall, however, while the


individual may face difficulties and challenges, the levels of educational attainment do not differ statistically for those with IBD from the general population or a healthy comparison group. No costs or deficits were assessed for impact on education.


SHORT-TERM WORK LOSSES


Employed people with IBD may miss work due to medical appointments, illness, or hospitalization.


At a minimum, days spent in hospital must be days missed from work, for those who are employed. In reality, the true number of days missed from work is much higher. In order to find


THE IMPACT OF INFLAMMATORY BOWEL DISEASE IN CANADA 55


Similarly, a UK study found that 24% of people with Finally, IBD can have a


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