Impact of Rhinitis on Work Productivity: A Systematic Review

doi:10.1016/j.jaip.2017.09.002

The Journal of Allergy and Clinical Immunology: In Practice

Volume 6, Issue 4, July–August 2018, Pages 1274-1286.e9

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https://doi.org/10.1016/j.jaip.2017.09.002 Get rights and content

Background

Allergic rhinitis (AR) is increasingly acknowledged as having a substantial socioeconomic impact associated with impaired work productivity, although available information remains fragmented.

Objective

This systematic review summarizes recently available information to provide a quantitative estimate of the burden of AR on work productivity including lost work time (ie, absenteeism) and reduced performance while working (ie, presenteeism).

Methods

A Medline search retrieved original studies from 2005 to 2015 pertaining to the impact of AR on work productivity. A pooled analysis of results was carried out with studies reporting data collected through the validated Work Productivity and Activity Impairment (WPAI) questionnaire.

Results

The search identified 19 observational surveys and 9 interventional studies. Six studies reported economic evaluations. Pooled analysis of WPAI-based studies found an estimated 3.6% (95% confidence interval [CI], 2.4; 4.8%) missed work time and 35.9% (95% CI, 29.7; 42.1%) had impairment in at-work performance due to AR. Economic evaluations indicated that indirect costs associated with lost work productivity are the principal contributor to the total AR costs and result mainly from impaired presenteeism. The severity of AR symptoms was the most consistent disease-related factor associated with a greater impact of AR on work productivity, although ocular symptoms and sleep disturbances may independently affect work productivity. Overall, the pharmacologic treatment of AR showed a beneficial effect on work productivity.

Conclusions

This systematic review provides summary estimates of the magnitude of work productivity impairment due to AR and identifies its main determinant factors. This information may help guide both clinicians and health policy makers.

Section snippets

Protocol

This SR was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (www.prisma-statement.org).¹⁶

Results

The 30 selected studies included 19 observational surveys17, 18, 19, 20, 21, 22, 23, 25, 26, 27, 28, 29, 30, 40, 41, 43, 44, 45, 46 and 9 interventional studies.31, 32, 33, 34, 35, 36, 37, 38, 39 Six studies reported economic evaluations,18, 24, 32, 41, 42, 43 among which 3 were also identified among the observational surveys18, 41, 43 and 1 among interventional studies.³²

Summary of evidence

The pooled analysis of WPAI-based studies identified in this SR showed that AR is associated with a substantial adverse impact on the productivity at work (ie, presenteeism) with an estimated 35.9% (95% CI, 29.7; 42.1%) impairment, whereas the impact on absenteeism was minimal (3.6% [95% CI, 2.4; 4.8%]). These figures are similar to previous estimates of absenteeism, whereas estimates of impaired productivity at work are higher than those reported in previous US surveys that used various

Conclusions

This SR indicates that AR is substantially impairing at-work productivity (presenteeism) but only minimally absenteeism, although further studies assessing daily work productivity and severity of symptoms at the same time over prolonged periods and comparing with other chronic diseases are needed to better characterize the impact of AR. Nevertheless, the findings of this SR should increase the awareness of the medical community on the impact of AR on work productivity and provide an

Acknowledgements

OV and JB contributed to the development of the bibliographic search strategy, the risk of bias assessment strategy and data extraction criteria. DV, PD, JJ, LT, and XZ provided statistical expertise. OV, PD, and JB drafted the manuscript. All authors read, provided feedback, and approved the final manuscript. OV acts as guarantor of the manuscript.

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: This work was partly supported by the European Structural and Development Funds (Région Languedoc-Roussillon). OV was supported by a grant from the Fondation Louvain (Legs Pierre De Merre).

: Conflicts of interest: D. Price (all fees paid to Observational and Pragmatic Research Institute) is a board member for Aerocrine, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis, and Teva Pharmaceuticals; has received consultancy fees from Almirall, Amgen, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Meda, Mundipharma, Napp, Novartis, Pfizer, Teva Pharmaceuticals, and Theravance; has received research support from UK National Health Service, British Lung Foundation, Aerocrine, AKL Ltd, AstraZeneca, Boehringer Ingelheim, Chiesi, Meda, Mundipharma, Napp, Novartis, Pfizer, Respiratory Effectiveness Group, Takeda, Teva Pharmaceuticals, Zentiva, and Theravance; has received lecture fees from Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Kyorin, Meda, Merck, Mundipharma, Novartis, Pfizer, Skyepharma, Takeda, and Teva Pharmaceuticals; has received fees for manuscript preparation from Mundipharma and Teva Pharmaceuticals; has received travel support from Aerocrine, Boehringer Ingelheim, Mundipharma, Napp, Novartis, Teva Pharmaceuticals, and AstraZeneca; has received payment for patient enrollment or completion of research from Chiesi, Teva Pharmaceuticals, Zentiva, and Novartis; has received payment for developing educational materials from Novartis and Mundipharma; has stock/stock options from AKL Ltd which produces phytopharmaceuticals; and owns 74% of the social enterprise Optimum Patient Care Ltd, UK, and 74% of Observational and Pragmatic Research Institute Pte Ltd, Singapore. A. L. Valero has received consultancy fees from FAES, Orion Pharma, Novartis, Sanofi, Stallergenes, Meda, GlaxoSmithKline, Chiesi, AstraZeneca, Zambon Esteve, Uriach, and VIFOR; and has received research support from Novartis, Leti, Uriach, and Meda. J. Bousquet has received personal fees for being on the scientific and advisory board for Almirall, Meda, Merck, MSD, Novartis, Sanofi-Aventis, Takeda, Teva, and Uriach; and has received lecture fees from Almirall, AstraZeneca, Chiesi, GSK, Meda, Menarini, Merck, MSD, Novartis, Sanofi-Aventis, Takeda, Teva, and Uriach. The rest of the authors declare that they have no relevant conflicts of interest.

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Original ArticleImpact of Rhinitis on Work Productivity: A Systematic Review

Background

Objective

Methods

Results

Conclusions

Section snippets

Protocol

Results

Summary of evidence

Conclusions

Acknowledgements

J Clin Epidemiol

J Allergy Clin Immunol

J Clin Epidemiol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

Ann Allergy Asthma Immunol

Ann Allergy Asthma Immunol

The importance of rhinitis on sleep, daytime somnolence, productivity and fatigue

Curr Opin Pulm Med

The burden of allergic rhinitis

Allergy Asthma Proc

Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen)

Allergy

Rhinitis and its impact on work

Curr Opin Allergy Clin Immunol

Pharmacotherapy of allergic rhinitis: a pharmaco-economic approach

Allergy

The cost and impact of health conditions on presenteeism to employers: a review of the literature

Pharmacoeconomics

Allergic rhinitis: direct and indirect costs

Allergy Asthma Proc

Economic burden of inadequate management of allergic diseases in the European Union: a GA(2) LEN review

Allergy

Costs of hay fever in the United States in 1990

Ann Allergy

The cost of productivity losses associated with allergic rhinitis

Am J Manag Care

Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers

J Occup Environ Med

A review of self-report instruments measuring health-related work productivity: a patient-reported outcomes perspective

Pharmacoeconomics

Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation

BMJ

Economic impact of workplace productivity losses due to allergic rhinitis compared with select medical conditions in the United States from an employer perspective

Curr Med Res Opin

Relationship of nasal congestion with sleep, mood, and productivity

Curr Med Res Opin

The impact of allergic rhinitis on work productivity

Prim Care Respir J

Sleep, quality of life, and productivity impact of nasal symptoms in the United States: findings from the Burden of Rhinitis in America survey

Allergy Asthma Proc

The current burden of allergic rhinitis amongst primary care practitioners and its impact on patient management

Prim Care Respir J

Nasal allergies in the Latin American population: results from the Allergies in Latin America survey

Allergy Asthma Proc

Economic burden of allergic rhinitis in Korea

Am J Rhinol Allergy

Allergic rhinitis and its impact on work productivity in primary care practice and a comparison with other common diseases: the Cross-sectional study to evAluate work Productivity in allergic Rhinitis compared with other common diseases (CAPRI) study

Am J Rhinol Allergy

Nasal allergies in the Asian-Pacific population: results from the Allergies in Asia-Pacific Survey

Am J Rhinol Allergy

Burden of allergic rhinitis: allergies in America, Latin America, and Asia-Pacific adult surveys

Allergy Asthma Proc

The burden of allergic rhinitis (AR) in Canada: perspectives of physicians and patients

Allergy Asthma Clin Immunol

Original Article
Impact of Rhinitis on Work Productivity: A Systematic Review