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INDIRECT COSTS


key findings:


• People with IBD have a lower labour participation rate (3-13%) than the general population.


• The costs of reduced labour participation could range from $326 million (with 3% non-participation) to $1.4 billion (with 13% non-participation due to IBD). The best estimate is a minimum of $979 million (9% non-participation – 21,000 individuals).


Premature Retirement


Premature retirement was investigated in one Swedish study. This study looked at people with CD only. The investigators reviewed national registers of social services and determined that each year, approximately 1% of the CD population was granted early retirement pensions, with an average duration of 14 years of early retirement.90


In Canada, with 129,000 people


living with CD, there could be 1,290 persons taking premature retirement due to CD each year. However, it is difficult to separate these cases from the preceding analysis on long-term employment impact. Long-term absence could be from people who did not enter the workforce, but also from premature retirement (people who entered the work force, but left early). To avoid the potential for double-counting, there was no separate calculation for premature retirement in the analysis.


• Costs from premature retirement were assumed to be included in the estimate of costs from long-term work absences.


Premature Mortality


From a purely economic standpoint, premature mortality from IBD can cause productivity losses to society. In Canada, there were an average of 85 deaths due to CD and 43 deaths due to UC per year from 2004-2008 (most recent data available).91


Of these, there are an


average of 30 deaths from CD and 14 deaths from UC in people under the age of 65 (the typical cut-off for the working population). Based on the mortality analysis, UC does not cause excess mortality. It can be conservatively assumed that none of the UC deaths contributed to productivity losses. That is, these deaths would have occurred even in the absence of UC. Therefore, the focus was on CD only.


Of the 30 deaths per year in CD, assuming that 60% of people with IBD are employed, then there would be 18 deaths in potentially employable people with CD. The average age at death was 49 for those who died before age 65; this corresponds to 16 years of lost employment. There would be a productivity loss of $523,000 per person, or $9.4 million for the 18 premature deaths each year.


key findings:


• There are 18 deaths per year in employed people with CD, at an average age of 49 years. The productivity loss associated with these deaths is $9.4 million. • No costs were assigned to premature deaths in people with UC.


THE IMPACT OF INFLAMMATORY BOWEL DISEASE IN CANADA 58


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