In Absence of Absenteeism: Some Thoughts on Productivity Costs in Economic Evaluations in a Post-corona Era

Growth and changing landscape of the cost-utility literature: an Australian perspective, 1992-2022

BACKGROUND

Since the introduction of cost-utility analysis (CUA) in the 1990s, its methodologies and applications have evolved significantly in Australia.

OBJECTIVES

To provide a comprehensive overview of the volume, trends, and characteristics of the application of CUA in healthcare decision-making.

METHODS

Bibliometric analysis of published CUAs identified from the Cost-Effectiveness Analysis Registry, a `1comprehensive source of CUA data between 1992 and 2022. Multinomial logistic regression models were conducted to explore the associations between ICERs and variables including sponsorship, perspective, and discount rate.

RESULTS

N = 484 unique Australian-based CUAs were analysed. Over the last three decades, the volume and quality of CUAs in Australia have steadily increased. Commonly evaluated interventions included pharmaceuticals (21.5 %), health education/behaviour (18.0 %), and models of care (16.6 %), while diseases of circulatory system, cancers, and metabolic diseases were the most studied health conditions. Only nine CUAs involved First Nations people. Most CUAs (72.9 %) were conducted from a healthcare payer perspective, with only 19.0 % adopting a societal perspective. Approximately half of studies applied a 5 % discount rate, and 50.4 % used a $50,000 WTP threshold. 14.7 % CUAs were sponsored by industry. Regression analyses showed that industry sponsorship, societal perspective, and lower discount rate were positively associated with lower ICERs.

CONCLUSIONS

The increasing volume of CUAs underscores the importance of efficient allocation of scare resources in Australian health system. However, gaps remain, particularly in the inclusion of First Nations populations and the societal costs. Further research is needed to address these gaps and to evaluate the impact of sponsorship and discounting on CUA outcomes.

Examination of Methods to Estimate Productivity Losses in an Economic Evaluation: Using Foodborne Illness as a Case Study

BACKGROUND

Cost-utility analyses commonly use two primary methods to value productivity: the human capital approach (HCA) and the friction cost approach (FCA). Another less frequently used method is the willingness-to-pay (WTP) approach, which estimates the monetary value individuals assign to avoiding an illness. In the context of foodborne illnesses (FBI), productivity loss represents one of the most significant economic impacts, particularly in developed nations. These losses arise from factors such as missed workdays, reduced workplace efficiency due to illness, and long-term health complications that can limit an individual's ability to work. As a result, accurately quantifying productivity loss is critical in understanding the broader economic burden of FBI.

AIM

Our aim was to compare the impact of valuation methods used to measure productivity loss in an economic evaluation, using a hypothetical intervention for FBI caused by campylobacter as a case study. Cost effectiveness from three perspectives is examined: health care system, employee, and employer.

METHOD

A Markov model with a 10-year time horizon was developed to evaluate the morbidity and productivity impacts of FBI caused by campylobacter. The model included four health states: 'healthy', 'acute gastroenteritis', 'irritable bowel syndrome and being unable to work some of the time', and 'irritable bowel syndrome and unable to work'. Five approaches to valuing productivity loss were compared: model 1 (cost-utility analysis), model 2 (HCA), model 3 (FCA), model 4 (FCA+WTP to avoid illness with paid sick leave), and model 5 (WTP to avoid illness without paid sick leave). Health outcomes and costs were discounted using a 5% discount rate. Costs were reported in 2024 Australian dollars ($AUD).

RESULTS

Model 1, which did not include productivity losses, yielded the highest incremental cost-effectiveness ratio (ICER) at $56,467 per quality-adjusted life-year (QALY) gained. The inclusion of productivity costs (models 2-5) significantly increased the total costs in both arms of the models but led to a marked reduction in the ICERs. For example, model 2 (HCA) resulted in an ICER of $11,174/QALY gained, whereas model 3 (FCA) resulted in $21,136/QALY gained. Models 4 and 5, which included WTP approaches, had ICERs of $19,661/QALY gained and $24,773/QALY gained, respectively.

CONCLUSION

These findings underscore the significant impact of different modelling approaches to productivity loss on ICER estimates and consequently the decision to adopt a new policy or intervention. The choice of perspective in the analysis is critical, as it determines how the short-term and long-term productivity losses are accounted for and valued. This highlights the importance of carefully selecting and justifying the perspective and valuation methods used in economic evaluations to ensure informed and balanced policy decisions.

Presenteeism Caused by Health Conditions and Its Economic Impacts Among Japanese Workers in the Post-COVID-19 Era

OBJECTIVES

This study investigated the common health conditions leading to presenteeism and the economic impact among Japanese workers in the post-COVID-19 era.

METHODS

Between February and March 2023, 10,000 workers responded to a web-based, cross-sectional survey on health problems that interfered with their work, degree of presenteeism, and teleworking status.

RESULTS

Approximately 35.6% of workers faced health problems that impacted their work. The primary health problems leading to presenteeism were low back pain, neck pain/stiff shoulders, and mental illness, which varied slightly with age and work style. The estimated annual costs due to presenteeism per 1000 employees were $488,210 for low back pain, $346,308 for neck pain/stiff shoulders, and $327,137 for mental illness.

CONCLUSIONS

Our findings suggest that presenteeism measures, primarily for musculoskeletal pain and mental health problems, are required to increase work productivity.

Production Losses due to Absenteeism and Presenteeism: The Influence of Compensation Mechanisms and Multiplier Effects

BACKGROUND

Productivity costs can form a large and influential component of total costs in an economic evaluation taking a societal perspective. In calculating productivity costs, estimating productivity losses is a central element. Compensation mechanisms and multiplier effects may influence these losses but remain understudied. Compensation mechanisms could reduce productivity losses while multiplier effects may increase them.

METHODS

Data on productivity losses were collected in 2015 using an online survey among a sample of persons aged 15-65 years in The Netherlands who worked at least 12 h per week and reported to have experienced absenteeism and/or presenteeism during the past 4 weeks. A total of 877 respondents completed the survey that contained questions on productivity losses, compensation mechanisms, and multiplier effects.

RESULTS

We found that 45.5% of the respondents reported absenteeism (average 6.5 days) during the past 4 weeks, losing on average 48.7 working hours, while presenteeism was experienced by 75.9% of respondents, with an average loss of 10.7 working hours. Compensation mechanisms were reported by 76.9% of respondents, compensating almost 80% of their lost production, while multiplier effects were reported by 23.6% of respondents, reducing the productivity of 4.2 colleagues by 27.8% on average, implying a multiplier of 2.1 in that subgroup.

CONCLUSIONS

This study highlights that compensation mechanisms and multiplier effects are common and may substantially affect production losses. Investigating these mechanisms and effects further, as well as their interactions, remains important. Translating these findings into productivity cost calculations in economic evaluations is not straightforward and requires attention, especially since compensation mechanisms may not be costless and, for multiplier effects, the value of hours of colleagues may not be similar to that of the person experiencing health problems.

Multiplier Effects and Compensation Mechanisms for Inclusion in Health Economic Evaluation: A Systematic Review

BACKGROUND

Compensation mechanisms and multiplier effects may affect productivity losses due to illness, disability, or premature death of individuals. Hence, they are important in estimating productivity losses and productivity costs in the context of economic evaluations of health interventions. This paper presents a systematic literature review of papers focusing on compensation mechanisms and multiplier effects, as well as whether and how they are included in health economic evaluations.

METHODS

The systematic literature search was performed covering EconLit and PubMed. A data-extraction form was developed focusing on compensation mechanisms and multiplier effects.

RESULTS

A total of 26 studies were included. Of these, 15 were empirical studies, three studies were methodological studies, two studies combined methodological research with empirical research, four were critical reviews, one study was a critical review combined with methodological research, and one study was a cost-benefit analysis. No uniform definition of compensation mechanisms and multiplier effects was identified. The terminology used to describe compensation mechanisms and multiplier effects varied as well. While the included studies suggest that both multipliers as well as compensation mechanisms substantially impact productivity cost estimates, the available evidence is scarce. Moreover, the generalizability as well as validity of assumptions underlying the calculations are unclear. Available measurement methods for compensation mechanisms and multiplier effects differ in approaches and are hardly validated.

CONCLUSION

While our review suggests that compensation mechanisms and multiplier effects may have a significant impact on productivity losses and costs, much remains unclear about their features, valid measurement, and correct valuation. This hampers their current inclusion in economic evaluation, and therefore, more research into both phenomena remains warranted.

Systematic Literature Review of the Use of Productivity Losses/Gains in Cost-Effectiveness Analyses of Immune-Mediated Disorders

INTRODUCTION

In light of the lack of an agreed international standard for how to conduct cost-effectiveness analyses (CEAs), including cost-utility analyses (CUAs) from a societal perspective, there is uncertainty regarding to what extent the inclusion of productivity losses/gains in economic evaluations can affect cost-effectiveness results and subsequently decisions on whether to recommend new health technologies. To investigate this, we conducted a systematic review of CEAs and CUAs of drug-based therapies for a set of chronic immune-mediated disorders to understand how cost elements and calculation methods related to productivity losses/gains are used, examine the impact on the incremental cost-effectiveness ratio (ICER) of including productivity costs, and explore factors that affect the inclusion of productivity loss.

METHODS

Databases (MEDLINE® In-process, MEDLINE, Embase and Cochrane Library) were searched from January 2010 to October 2020 by two independent reviewers for all CEAs and CUAs in adults with any of the following conditions: ankylosing spondylitis, chronic idiopathic urticaria, Crohn's disease, fibromyalgia, juvenile idiopathic arthritis, psoriasis, rheumatoid arthritis, systemic lupus erythematosus and ulcerative colitis. Relevant study data were extracted and evidence was synthesized for both qualitative and quantitative analysis. Productivity cost elements including absenteeism, presenteeism, unemployment/early retirement, premature mortality and informal care were extracted, along with the method used to determine them. A multivariate analysis was performed to identify factors associated with the inclusion of productivity loss.

RESULTS

Our searches identified 5016 records, culminating in 198 unique studies from 234 publications following screening. Most of the studies investigated rheumatoid arthritis (37.0%) or psoriasis (32.0%). The majority were CUAs, with some including both a CEA and a CUA (73.0%). Most studies used a payer perspective only (28.5%) or a societal perspective only (21.0%). Of the 49 studies incorporating productivity losses/gains, 42 reported the type of cost element used; all of these used patient absenteeism, either alone or in addition with other elements. Only 16 studies reported the method used to value productivity changes, of which eight used a human capital approach, four used a friction cost approach and four used both approaches. Twenty-eight of the 49 studies (57.1%) reported inclusion of productivity losses/gains as contributing to more favourable cost-effectiveness outcomes and ICERs, while 12 (24.5%) reported no substantial impact. On the basis of a multivariate analysis, rheumatoid arthritis as the target disease had a statistically significant association with the inclusion of productivity loss compared with psoriasis and inflammatory bowel disease.

CONCLUSIONS

The results of our review suggest that incorporating productivity cost elements may positively affect cost-effectiveness outcomes in evaluations of therapeutics for immune-mediated disorders. Our work highlights the continued need for clarity when reporting how CEAs and CUAs in this disease area are conducted, in order to better inform healthcare decision-making.

Economic evaluations of interventions against viral pandemics: a scoping review

OBJECTIVES

The COVID-19 pandemic has led to suggestions that cost-effectiveness analyses should adopt a broader perspective when estimating costs. This review aims to provide an overview of economic evaluations of interventions against viral pandemics in terms of the perspective taken, types of costs included, comparators, type of economic model, data sources and methods for estimating productivity costs.

STUDY DESIGN

Scoping literature review.

METHODS

Publications were eligible if they conducted a cost-effectiveness analysis, cost-utility analysis, cost-benefit analysis or cost-minimisation analysis and evaluated interventions aimed at viral pandemics or for patients infected with viral pandemic disease. We searched PubMed, Embase and Scopus for relevant references and charted data from the selected full-text publications into a predefined spreadsheet based on research sub-questions, summary tables and figures.

RESULTS

From 5410 references, 36 full-text publications fulfilled the inclusion criteria. The economic evaluations were mainly model based and included direct medical costs of hospital treatment. Around half of the studies included productivity costs and the proportion of total costs attributed to productivity costs ranged from 10% to 90%, depending on estimation methods, assumptions about valuation of time, type of intervention, severity of illness and degree of transmission.

CONCLUSIONS

Economic evaluations of interventions against viral pandemics differed in terms of estimation methods and reporting of productivity costs, even for similar interventions. Hence, the literature on economic evaluations for pandemic response would benefit from having standards for conducting and reporting economic evaluations, especially for productivity costs.