bh IN BRIEF

Canada has among the highest prevalence and incidence rates of ulcerative colitis in the world. Approximately 104,000 Canadians are living with the disease and over 4,500 new cases are diagnosed each year. ¹  The economic costs are high and include lost productivity. The impact on quality of life can be devastating for patients and their families. 

1. What is ulcerative colitis (UC)? What age group is most often affected by UC? How significant a cause of long or short-term disability is UC? 

UC is chronic inflammation of the lining of the colon or large intestine. The inflammation can range along a spectrum from mild, like a sunburn, to severe that causes damage like blisters and craters in the colon as well as cramps and diarrhea. In extreme cases the inflammation may destroy the colon so that surgery is required. The actual cause is still unknown but we know that it is mediated by the immune system. UC tends to affect a younger population – never newborns – but including children, teens and young adults of working age. On the other hand, UC can develop at any age. Its effects are variable. In some cases, UC can be put into remission with mild medication and patients experience little disability. In other cases, further along the spectrum, UC is never under control, and patients feel systemically unwell and are unable to work.

2. They say that surgery (removing the colon or colectomy) is curative for UC.  Is that really true?  What patients just aren’t candidates for colectomy? 

Removal of the colon can be life-saving and improve the symptoms of patients who don’t respond to therapy, allowing them to avoid the side-effects of  medications. However, colectomy is not curative for three reasons: 1) if patients have their inflammed bowel removed and have an ileostomy or external pouch for the collection of wastes, some inflammation remains, even though a majority of the inflamed bowel has been removed; 2) if patients have complete surgery and an internal pouch is created, they often still get recurring inflammation called “pouchitis” which can also cause diarrhea and pain; and 3) patients may still be prone to other autoimmune complications that can affect the liver, skin and joints. 

3.What is the role of pharmaceuticals, especially biologics, in the treatment of UC? 

UC is treated in “step up” fashion, which means moving from less expensive and less toxic to more expensive and more powerful pharmaceuticals. About 40% to 50 % of patients do fairly well at the lowest level which usually includes use of a drug called “mesalamine.” Another group, however, needs prednisone which can have expensive side effects (e.g. more doctor visits) and can lead to other diseases such as osteoporosis and diabetes. Biologics are a step up from prednisone. Most who need to move to a biologic do reasonably well and may go into complete and prolonged remission. Further, use of biologics is relatively recent, and new biologics are appearing every year raising the possibility that they will benefit even more patients.  

4. What benefits do plan sponsors incur from providing reimbursement coverage for the biologics to treat UC?  Have you seen patients who have UC be able to transfer from work absence to productive lives after being treated with a biologic agent?

The majority of patients who require biologics have reduced productivity and/or are unable to work. After being treated with a biologic, the vast majority of patients can return to work and resume productivity. Cost/benefit analyses of the use of biologic agents that include wages and productivity show that the use of biologics is cost effective. Most physicians want to make patients feel better and be more productive. A short time off and pharmaceuticals can pay dividends. 

5. How can employers help patients with chronic health issues like UC?  Are there accommodations that could be made in the workforce for patients with UC that could help them manage their disease or productivity?

The most important workplace accommodations for employees with UC are physical access to washroom facilities and understanding managers who allow employees time to use them. UC patients often have little warning of the need to use the washroom and, in most cases, much of the pain associated with UC improves after a bowel movement. Managers also need to recognize that employees with UC are likely to be absent more often than other employees – they have more doctor visits and need more procedures for medical maintenance. Also, having UC can complicate the treatment of other illnesses. Further, UC has social/emotional effects. Many patients are not only less productive and possibly unable to work, they cannot take part in day to day activities that others take for granted. Evidence suggests that when patients experience psychological stress, their disease worsens. Patients need understanding and support at work.