Comparison of work productivity losses in the United States among employees with COVID-19 at high-risk of severe disease who were untreated or treated with nirmatrelvir/ritonavir.

AIM: Nirmatrelvir-ritonavir (NMV/r; Paxlovid) treatment reduces COVID-19-related morbidity, mortality, and direct healthcare burdens. To investigate the potential impact of NMV/r on indirect disease burdens, we compared workplace productivity between employees diagnosed with COVID-19 who were and were not treated with NMV/r.

METHODS

Adult employees with COVID-19 at high-risk of severe disease were identified in the Merative MarketScan Health and Productivity Management Database. Index date was the first COVID-19 diagnosis on or after 12/16/2021; employees were followed over a six-month pre-period and ≥30-day post-period. Individuals treated with NMV/r (claim within 5 days of index) were exactly matched 1:1 to untreated employees based on age, sex, index quarter, Charlson Comorbidity Index, and pre-period acute care visits. Lost workdays per-patient-per-month (PPPM) and associated estimated indirect costs due to absence, short-term disability (STD), or long-term disability (LTD) were compared between matched treated and untreated cohorts over the variable post-period using paired t-tests or Chi-squared tests and two-part hurdle models.

RESULTS

Treated and untreated absence, STD, and LTD analyses included n = 1,909, n = 20,065, and n = 20,318 employees respectively. NMV/r treatment was associated with significantly fewer lost workdays PPPM from absence (mean[SD]: 2.06[2.37] vs. 2.22[2.49], p < 0.05), STD (0.41[2.17] vs. 0.52[2.42], p < 0.001), and LTD (0.02[0.061] vs. 0.04[0.79], p < 0.05) in descriptive analyses. Marginal means from combined two-part hurdle models confirmed treated employees had 5% fewer absence days (mean ratio[95% CI]:0.95[0.91, 0.99]), 17% fewer STD days (mean ratio[95% CI]:0.83[0.77, 0.88]), and 27% fewer LTD days (mean ratio[95% CI]:0.73[0.69, 0.78]) compared to untreated patients (p < 0.01).

LIMITATIONS: The study sample was derived from large self-insured employers; results may not generalize to small employers or the uninsured and do not reflect other types of productivity loss (e.g. presenteeism).

CONCLUSION

Within this sample of high-risk employees, NMV/r therapy was associated with reduced societal burdens following COVID-19 infection.