Productivity loss and indirect costs in the year following acute coronary events in Switzerland

Acute coronary syndrome (ACS) is highly prevalent in Switzerland and a leading cause of death. Associated productivity loss and indirect costs have rarely been studied. We investigated these factors in the first year after ACS in 24 Swiss patients (mean (SD) age 56 (8) years, 79% male). Data on patient productivity loss, absenteeism, presenteeism and caregiver assistance, were collected with the Productivity Cost Questionnaire during a routine cardiologist visit 3 to 12 months after hospitalisation for ACS and at least 4 weeks after patients returned to work. To estimate costs, lost hours were converted into 8-hour workdays, pro-rated to 1 year, combined with time off work due to initial hospitalisation and sick leave, and valued at Swiss labour costs. Additional data came from medical records. ACS patients lost on average (SD, range) 79 (81, 0.3–294) workdays; 38 (36, 0.3–153) days due to the initial hospitalisation and sick leave, 37 (75, 0–243) due to absenteeism after patients returned to work, and 4 (11, 0–41) due to presenteeism. Caregivers lost 10 (23, 0–90) additional workdays. The total indirect costs amounted to CHF 43,205 (44,026, 122–148,648); including CHF 18,514 (17,507, 122-74,619) for initial hospitalisation and sick leave and CHF 17,988 (36,394, 122–143,277) and CHF 1,849 (5181, 0–20,158) for absenteeism and presenteeism after patients returned to work, respectively. Costs of caregiver assistance amounted to CHF 4,855 (11,015, 0–43,843). This study showed that ACS patients lost on average 36% of their annual productive time. Caregivers lost an additional 5%. Lost work time was associated with substantial indirect costs that exceeded estimates of direct costs for ACS during 1 year. This suggests that costs and burden could be reduced through better risk reduction management.

Low sense of coherence in long-term follow up of adolescents with anorexia nervosa

Background: Sense of coherence is a personal resource known to be low in eating disorders. We wanted to know if sense of coherence is still correlated to anorexia symptoms several years after initial hospitalisation for anorexia. Methods: 86 former female patients diagnosed with anorexia were contacted 5-11 years after hospitalisation in a German hospital; 68 of 149 women (46%) could be contacted and agreed to participate in a survey with the Eating Disorder Inventory (EDI-2) and the Sense of Coherence Questionnaire (SOC-13). Results: 17.6% of participants stated that they suffered from an eating disorder currently, with 7.4% having anorexia nervosa. Mean EDI-2 subscales (except for the bulimia sub-scale) were in the <40th percentile for women with anorexia. Sense of coherence was low (percentile rank 20). All EDI-2 subscales correlated negatively with the SOC-13 score (p<0.01). Conclusions: The sense of coherence is low in long-term follow up of anorexia nervosa and is correlated with on-going anorexia symptoms.