The effect of self-assessed fatigue and subjective cognitive impairment on work capacity: the case of multiple sclerosis1

Gisela Kobelt, Dawn Langdon and Linus Jönsson
Multiple Sclerosis Journal (2018) DOI: 10.1177/13524585187

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Introduction

  • MS is a highly disabling disease that has a substantial impact on work capacity,2,3 which is of particular relevance for economic assessment4
  • Data from a large, international, cross-sectional study was used to investigate work impairment associated with the presence of fatigue and subjective cognitive impairment (SCI)2,3
  • Despite the public debate about the role of production losses in decisions about public funding of treatments, few funders include them formally in their decision-making5,6
  • The probability of being employed is lower in those with MS than for the general public; patients with MS commonly work shorter hours, take more sick leave, have poorer work performance and retire earlier2,3
  • Disability, as measured by the EDSS, focuses predominantly on ambulation, and has been shown to be a strong predictor of workforce participation3
  • However, EDSS does not capture common, prominent, non-physical MS symptoms such as fatigue and SCI, which may also play a role in the decision to reduce or abandon employment
View details of the methods used in this study

The MS cost of illness study of more than 16,000 responses across 16 European countries concluded that the majority of working age people with MS are not working1

Novel insights on the impact of MS on employment

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Only
0%

of working age respondents with MS were gainfully employed or self-employed

(n=13,796)

Many more people with MS were working part time or reduced hours (n=16,207)
View the EDSS scale in more information

In all patients working, the number of hours worked per week decreases as the severity of the disease increases

In the patients that were of working age, the percentage employed or self-employed decreases as the severity of the disease increases

*All patients working. Percentage of patients of working age

Reduced workforce participation starts early in the disease course of MS1

Novel insights on the impact of MS on employment (n=16,207)

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Proportion of employed or self-employed people with MS
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Patients with mild MS will range from having no disability and only minimal signs of MS in one functional system to having moderate disability in one functional system or mild disability in three or four functional systems. No walking impairment is experienced at this stage.

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Patients with moderate MS have significant disability which may impair their full daily activities and their ability to work a full day without special provisions. Patients with moderate MS can typically walk between 500m to 200m without aid or rest.

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Patients with severe MS are considerably more disabled, with MS hindering multiple areas of daily living. Patients with EDSS 6 to 7 will have limited walking capacity, requiring walking aids and only able to walk between 100m and 5m, with those at EDSS 7 essentially wheelchair bound but able to transfer themselves.

Those with MS at EDSS 8 to 9 are essentially restricted to a chair or a bed for much of or all of the day. patients may retain some self care functions but at EDSS 9 this will usually be lost.

  • Mild MS
  • Moderate MS
  • Severe MS

*compared with no disability

Ability to work

Of the 58% of those not working,

0%

reported that they were not employed due to their MS

* compared with no disability

The probability that a person with MS would be working was related to their geographic location, gender and levels of education1

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Spain*

54%
less likely to be working than Germany
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Italy

5%
less likely to be working than Germany
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Switzerland

38%
more likely to be working than Germany
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Netherlands

48%
less likely to be working than Germany
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Sweden*

71%
more likely to be working than Germany
Gender

men were

0%

more likely to be employed or self-employed compared to females*

Education

Those with higher educational levels were more likely to be working

Primary School

75%

High School

53%

Professional Diploma

41%

Click on a circle above to learn more.

less likely to be working if only educated to Primary School Level…

less likely to be working if only educated to High School Level…

less likely to be working if only educated to Professional Diploma Level…

…compared with a University diploma

* p<0.0001. Please note: If the OR is > 1 the control is better than the intervention. If the OR is < 1 the intervention is better than the control. CI, confidence ratio; Probabilities were determined from odds ratios.

Among those working, fatigue and cognitive difficulties were the main reasons for reduced work productivity

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Effect of MS on people who were working3
Click on a pill button to learn more about cognitive impairment in MS and how it is measured 70%
of respondents reported fatigue as a reason for reduced work productivity
34%
of respondents reported cognitive difficulties as a reason for reduced work productivity
  • Fatigue
  • Cognitive difficulties

The negative impact on fatigue and cognition was evident, even in people with mild MS

Probability of working1
0% 0%

Increasing severity of fatigue and cognitive problems was directly related to the reduction in regular work hours among people with MS1

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Short-term sick leave
0%

of those working and not on long term sick leave had been on sick leave in the past 3 months

0 0 0

MSP-EU+-0216

References

  1. Kobelt G, Langdon D, Jonsson L. The effect of self-assessed fatigue and subjective cognitive impairment on work capacity: the case of multiple sclerosis. Mult Scler. 2018 Apr 1:1352458518769837.
  2. Ernstsson O, Gyllensten H, Alexanderson K, et al. Cost of illness of multiple sclerosis: A systematic review. PLoS ONE 2016; 11: e0159129.
  3. Kobelt G, Thompson A, Berg J, et al. New insights into the burden and costs of multiple sclerosis in Europe. Mult Scler 2017; 23: 1123–1136.
  4. Kobelt G. Health economic issues in MS. Int MS J 2006; 13: 17–26.
  5. Jönsson B. Ten arguments for a societal perspective in the economic evaluation of medical innovations. Eur J Health Econ 2009; 10: 357–359.
  6. Johannesson M, Jönsson B, Jönsson L, et al. Why should economic evaluations of medical innovations have a societal perspective? London: Office of Health Economics, 2009.