Work Disability and the Cost-effectiveness of Drugs to Treat Rheumatic Diseases — Time for a New Dialogue?
Bibliographic record
Abstract
Iragorri, et al , in this edition of The Journal , report a systematic review of the effect of biologics and targeted synthetic drugs on work outcomes in psoriatic arthritis (PsA)1. The paper raises several points of interest on the challenges facing investigators in the assessment of work disability and the current methods of judging the cost-effectiveness of treatments for PsA. Patient-reported work disability has gained increasing traction as an important outcome in rheumatic disease in recent years. Work is important to individuals (both financially and emotionally) and the economy as a whole. Access to appropriate healthcare is just one of the factors that can determine the health of a society (Figure 1). The ability to work can affect an individual’s living conditions and social interactions, and has spillover effects on future generations (including educational attainment). Therefore, ensuring that patients can remain at work while handling chronic disease, or return to work as soon as possible after periods of ill health, should be high priorities for those concerned with the health of the nation. Figure 1. The Dahlgren-Whitehead model. Used with permission: Dahlgren G, Whitehead M. Policies and strategies to promote social equity in health. Stockholm, Sweden: Institute for Futures Studies; 1991. In the context of longterm health conditions such as PsA, work disability may be significant and treatments to improve functional capability can affect not only health-related outcomes but also a patient’s ability to undertake productive work. The importance of work for an individual’s health and happiness is not a new concept. To Galen of Pergamon (AD 172) is attributed the quote, “Employment is nature’s physician, and is essential for human happiness,” reflecting the central role work plays … Address correspondence to W. Tillett, Royal National Hospital for Rheumatic Diseases, Rheumatology, Upper Borough Walls, Bath BA1 1RL, UK. E-mail: w.tillett{at}nhs.net
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.047 | 0.172 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.006 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.005 | 0.010 |
| Open science | 0.003 | 0.002 |
| Research integrity | 0.005 | 0.007 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".