By David Woods ([email protected])

Question: “How many people work in the public sector?”

Answer: “About half of them.”

It’s an old one, to be sure, but it has its echo in the fairly recently-coined word “presenteeism.” While absenteeism means not being at work at all; presenteeism means being at work, but not working; or at least not working to capacity.

That was the theme of a project presentation by 2008 MD/ MBA candidate Jeffrey Clough during Thomas Jefferson Medical College’s Health Policy Department’s Fellows’ Day. The project, funded by the Pharmaceutical Manufacturers and Research Association (PhRMA) and also involving Thomas Bunz, PharmD, as primary investigator, set out to examine the impact of pharmaceutical intervention in eight chronic disease entities: asthma, coronary artery disease (CAD), congestive heart failure (CHF), depression, diabetes, dyslipidaemia, hypertension, and migraine.

The project’s methodology involved searching literally thousands of articles using key words relating to the eight diseases and their connection to absenteeism and presenteeism. These eventually reduced to about 300–400 applicable or usable ones. The goal was to condense this wealth of information and make it understandable. With healthcare costs being such a major issue, the project’s findings would have an effect on decision making; in other words, which drugs can save money in productivity and worker satisfaction.

The two researchers found that from an employer or payer standpoint the impact more than compensated for the cost of medications in diseases such as asthma or where younger patients were more heavily involved; the return on investment was less or minimal in diseases such as CHF that primarily affect older patients.

Jeffrey Clough points out, though, that for some diseases an employer would likely see a return on investment (ROI) quickly in direct medical costs (e.g. diabetes, asthma) and in others there would be no ROI (e.g. dyslipidaemia); still others, he says, could yield a positive ROI if productivity costs are included (e.g. depression, migraine). The key point for decision makers, he emphasises, is not to evaluate medication costs as a single item but to think of all costs that could be affected.

There are ways to measure presenteeism, Mr Clough and Dr Bunz agree, but no standardised way to determine costs. How, for instance, can you assess the cost in lowered productivity of an arthritic patient’s ability with a computer?

PhRMA was allowed to comment and review at various stages in the genesis of the 10,000 word project; but the researchers emphasise that they have the final say. They believe that their work will be published in a peer-reviewed journal within the next six months. PhRMA will work with employers to show how if you use available pharmaceuticals appropriately you can improve outcomes economically as well as clinically.