Public health relevance of graves' orbitopathy

Abstract

Context: Disfiguring proptosis and functional impairment in patients with Graves' orbitopathy (GO) may lead to impaired earning capacity and to considerable indirect/direct costs. Objective: The aim of the study was to investigate the public health relevance of GO. Design and Setting: This cross-sectional study was performed between 2005 and 2009 at a multidisciplinary university orbital center. Patients: A total of 310 unselected patients with GO of various degrees of severity and activity participated in the study. Interventions: We conducted an observational study. Main Outcome Measures: We measured work disability and sick leave as well as the resulting indirect/direct costs of GO-specific therapies. Results: Of 215 employed patients, 47 (21.9%) were temporarily work disabled, and 12 (5.6%) were permanently work disabled. Five (2.3%) had lost their jobs, and nine (4.2%) had retired early. The mean duration of sick leave was 22.3 d/yr. Compared with the German average of 11.6 d/yr, 32 (15%) patients had taken longer sick leaves. The duration of sick leave correlated with the disease severity (P = 0.015), and work disability correlated with diplopia (P < 0.001). Multivariable analysis identified diplopia as the principal predictor for work disability (odds ratio, 1.7; P < 0.001). The average costs due to sick leave and work disability ranged between 3,301€ (4,153$) and 6,683€ (8,407$) per patient per year. Direct costs were 388 ± 56€ (488 ± 70$) per patient per year and per year were higher in sight-threatening GO(1,185 ± 2,569€; 1,491 ± 3,232$) than in moderate-to-severe (373 ± 896€; 469 ± 1,127$; P = 0.013) or in mild GO (332 ± 857€; 418 ± 1,078$; P = 0.016). Total indirect costs ranged between 3,318€ (4,174$) (friction cost method) and 6,738€ (8,476$) (human capital approach). Work impairment as well as direct and indirect costs of GO significantly correlated with the scores of the internationally standardized and specific GO quality-of-life questionnaire. Conclusions: Productivity loss and a prolonged therapy for GO incur great indirect and direct costs. Copyright © 2013 by The Endocrine Society.