Work Disability and the Cost-effectiveness of Drugs to Treat Rheumatic Diseases — Time for a New Dialogue?

Iragorri, et al , in this edition of The Journal , report a systematic review of the effect of biologics and targeted synthetic drugs on work outcomes in psoriatic arthritis (PsA)1. The paper raises several points of interest on the challenges facing investigators in the assessment of work disability and the current methods of judging the cost-effectiveness of treatments for PsA. Patient-reported work disability has gained increasing traction as an important outcome in rheumatic disease in recent years. Work is important to individuals (both financially and emotionally) and the economy as a whole. Access to appropriate healthcare is just one of the factors that can determine the health of a society (Figure 1). The ability to work can affect an individual’s living conditions and social interactions, and has spillover effects on future generations (including educational attainment). Therefore, ensuring that patients can remain at work while handling chronic disease, or return to work as soon as possible after periods of ill health, should be high priorities for those concerned with the health of the nation. Figure 1. The Dahlgren-Whitehead model. Used with permission: Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Stockholm, Sweden: Institute for Futures Studies; 1991. In the context of longterm health conditions such as PsA, work disability may be significant and treatments to improve functional capability can affect not only health-related outcomes but also a patient’s ability to undertake productive work. The importance of work for an individual’s health and happiness is not a new concept. To Galen of Pergamon (AD 172) is attributed the quote, “Employment is nature’s physician, and is essential for human happiness,” reflecting the central role work plays … Address correspondence to W. Tillett, Royal National Hospital for Rheumatic Diseases, Rheumatology, Upper Borough Walls, Bath BA1 1RL, UK. E-mail: w.tillett{at}nhs.net