The Estimation and Inclusion of Presenteeism Costs in Applied Economic Evaluation: A Systematic Review

The Association between COVID-19 Status and Economic Costs in the Early Stages of the COVID-19 Pandemic: Evidence from a UK Symptom Surveillance Digital Survey

INTRODUCTION

In the absence of a vaccination programme, the coronavirus disease 2019 (COVID-19) pandemic had substantial impacts on population health and wellbeing and health care services. We explored the association between COVID-19 status, sociodemographic, socioeconomic and clinical factors and economic costs during the second wave of the COVID-19 pandemic.

DATA

The study used patient-reported digital survey and symptom surveillance data collected between July and December 2020, in collaboration with a primary care computerised medical record system supplier, EMIS Health, in the UK. The study included 11,534 participants.

METHODS

Generalised linear models (GLM) and two-part regression models were used to estimate factors associated with economic costs (£sterling, 2022 prices) estimated from two perspectives: (i) a UK National Health Service (NHS) and personal social services (PSS) perspective and (ii) a societal perspective.

RESULTS

Experience of the onset of COVID-19 symptoms started more than 3 months ago was associated with significantly higher NHS and PSS costs (GLM: £319.8, two-part: £171.7) (p < 0.001) and societal costs (GLM: £776.9, two-part: £675.6) (p < 0.001) in both models. A positive test result within the previous 14 days was associated with significantly higher NHS and PSS costs (two-part: £389.1) (p < 0.05) and societal costs (GLM: £470.7, two-part: £439.2) (p < 0.01). Age between 31 and 55 years was associated with significantly higher societal costs than age between 16 and 30 years.

CONCLUSION

This study identifies and quantifies factors associated with the economic costs incurred during the second wave of the COVID-19 pandemic in the UK. The results of our study can inform cross-country comparisons and other cost comparisons.

Cost burden of productivity loss due to sickness presenteeism among nurses in South Korea: A cross-sectional study

AIM

This study aimed to estimate the annual cost burden of productivity loss due to sickness presenteeism among hospital nurses in South Korea.

BACKGROUND

Despite nurses being potentially more vulnerable to presenteeism, few studies have analyzed nurses' productivity losses due to sickness presenteeism.

METHODS

This cross-sectional study employed an online survey in January 2023 with 607 nurses working in general/tertiary hospitals in South Korea. The annual cost burden of productivity loss due to sickness presenteeism was calculated based on nurse health conditions, productivity loss, the number of days worked while sick, and income. This study was reported according to the STROBE checklist.

RESULTS

Overall, 93.2% of participants (n = 566) reported at least one health condition, and musculoskeletal diseases were the most prevalent, followed by weariness or fatigue, and sleep-related problems. Approximately 63.9% of participants reported experiencing sickness presenteeism in the preceding four weeks. Those in the severe multimorbidity group exhibited the highest prevalence of sickness presenteeism and productivity loss. The average annual cost of productivity loss due to sickness presenteeism was USD 2,388.26 per nurse and USD 382.11 million at the national level.

DISCUSSION

The cost of sickness presenteeism is high among hospital nurses in South Korea. Nurses with severe multimorbidity engaged in more sickness presenteeism and had higher productivity losses than nurses who were relatively healthy or exhibited moderate multimorbidity.

CONCLUSION

These findings support the need for stakeholders to develop strategies/policies to better address nurses' health conditions, secure better staffing, and reduce sickness presenteeism.

IMPLICATIONS FOR NURSING POLICY

Addressing this issue will not only improve nurse well-being and patient care but also lead to substantial cost savings for healthcare facilities. Additionally, the study findings can inform future cost-effectiveness studies.

Yoga, mindfulness and acupuncture impact on burnout: a preliminary meta-analysis

Mindfulness, yoga, and acupuncture are three practices that have received little attention in stress management literature, with scholars suggesting that they can improve physical and mental health, reduce stress and burnout, and boost productivity and job satisfaction. However, while there is growing interest in these practices, many employers remain sceptical about their potential benefits and are hesitant to invest resources in implementing them. This meta-analysis aimed to examine the impact of these practices on burnout and explore potential moderators. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure comprehensive and transparent reporting in the identification of eligible studies. Overall, 21 studies were included (8 on mindfulness, 7 on yoga, and 6 on acupuncture), all involving independent samples, with a total of 1,364 participants. The meta-analytic results showed that all three therapeutic practices have consistent and beneficial effects on reducing burnout. Furthermore, moderation analyses indicated that mindfulness interventions conducted within the work schedule have a significant reduction in burnout, while acupuncture interventions with between 4 or 8 weeks (the more weeks, the better) also reduced burnout. However, no significant moderation effect was observed for yoga interventions. Overall, the findings provide insights into the effectiveness of these complementary practices in reducing burnout and highlight the need for further research in this area.

Sickness presenteeism, job burnout, social support and health-related productivity loss among nurses in the Chinese nurses' health cohort study (TARGET): A cross-sectional survey

BACKGROUND

Sickness presenteeism has potential negative impacts on job burnout and health-related productivity loss among clinical nurses, whereas social support has been identified as a potential mitigating factor for such impacts. However, there is limited evidence regarding the relationships and mechanisms between sickness presenteeism, job burnout, social support, and health-related productivity loss.

OBJECTIVE

To explore the role of job burnout and social support in the association between sickness presenteeism and health-related productivity loss among female nurses.

DESIGN

A cross-sectional study.

SETTING(S)

105 hospitals conveniently selected from 36 cities in 15 provinces in China.

PARTICIPANTS

50,653 registered female nurses.

METHODS

This study utilizes the cross-sectional data from the baseline survey of the Chinese nurses' health cohort study (Towards A Revolution in GETting nurses' health ticked, TARGET), conducted from December 2020 to February 2024. Variables were measured using the Sickness Presenteeism Questionnaire, Stanford Presenteeism Scale, Maslach Burnout Inventory, and Perceived Social Support Scale. Data analyses were performed using independent sample t-tests, Pearson correlation analysis, one-way analysis of variance, multivariate linear regression analysis, and the Process 4.0 macro plug-in method.

RESULTS

A total of 42,843 valid questionnaires were collected with an 85% response rate. The incidence of sickness presenteeism among female nurses was 62 %. Sickness presenteeism was positively correlated with job burnout and health-related productivity loss, and job burnout was also positively correlated with health-related productivity loss. Conversely, social support was negatively associated with sickness presenteeism, job burnout and health-related productivity loss. The findings showed that the association between sickness presenteeism and health-related productivity loss was partially mediated by job burnout. Moreover, the direct and indirect effects within the mediation model were moderated by social support. When levels of social support were high, the impact of sickness presenteeism on job burnout and health-related productivity loss was weaker, as was the impact of job burnout on health-related productivity loss.

CONCLUSIONS

Hospital administrators and nurses themselves can mitigate the adverse effects of sickness presenteeism on health-related productivity loss by alleviating job burnout and increasing levels of social support. By addressing these significant challenges, they can more effectively manage the consequences of sickness presenteeism and job burnout among nurses.

REGISTRATION

The protocol of TARGET was registered in the China Clinical Trial Registry (ChiCTR2100043202).

TWEETABLE ABSTRACT

The study analyses TARGET data to explore the mechanisms between sickness presenteeism and health-related productivity loss.

The Economic Implications of Psychosocial Peer Support for Health Workers in German Hospitals

Purpose

The objective of this study is to evaluate whether the nationwide establishment and institutionalization of a peer-support program, is economically justified given the potential positive effects on the Second Victim Phenomenon (SVP) among healthcare professionals in Germany.

Methods

A comprehensive methodological approach was employed, using data from the SeViD studies to assess the prevalence and duration of SVP among physicians and nurses in Germany. Economic impact assessments were conducted to estimate the potential cost savings associated with implementing a peer-support program.

Results

The economic analysis reveals significant annual costs associated with SVP-induced absenteeism: approximately 1.56 billion euros for physicians and 1.87 billion euros for nurses. Implementing comprehensive peer-support programs could reduce these costs to approximately 0.85 billion (physicians) and 1.02 billion euros (nurses), respectively, demonstrating substantial potential economic benefits.

Conclusion

Investing in a structured peer-support program could yield annual savings exceeding 1.55 billion euros while enhancing workforce resilience and improving patient care. This underscores the economic rationale for scaling up peer support initiatives in healthcare settings.

Female teleworkers with pain have the highest presenteeism, where its primary contributing variable was not those of musculoskeletal disability

Presenteeism, among desk workers with pain can be affected by musculoskeletal disabilities (MSDs), working styles, and gender. In this study, teleworkers were defined as those who teleworked >70% of the time at home, while others were defined as non-full teleworkers. This study aimed to (1) compare the magnitude of presenteeism among four groups: male and female teleworkers with pain and male and female non-full teleworkers with pain, and (2) create a regression model of presenteeism with 66 independent biopsychosocial variables for each group. Data were collected through an anonymous online survey. Presenteeism was evaluated using the work functioning impairment scale. The 66 independent biopsychosocial variables included four disability measures, namely, stiff neck/shoulders, low back pain, and upper or lower limb problems, along with other factors relevant to presenteeism in previous studies, such as age, body mass index, comorbidities, work-related variables, pain catastrophizing, and various psychological distress measures. Data from 1,068 male non-full teleworkers, 1,043 female non-full teleworkers, 282 male teleworkers, and 307 female teleworkers were analyzed. Presenteeism was the highest among female teleworkers with pain. Furthermore, in all models, overall psychological distress, rather than the four MSD measures, was the primary contributing factor for presenteeism.

Social Costs of Smoking in the Czech Republic

OBJECTIVES

Smoking is an important risk factor leading to many diseases, which brings substantial healthcare costs as well as indirect costs due to decreased productivity. This article aims to quantify the social costs of smoking in the Czech Republic in 2019.

METHODS

The prevalence-based, cost-of-illness approach is used, which assesses the costs as the sum of direct (healthcare) costs and indirect costs (productivity losses due to mortality and morbidity). The costs of healthcare utilization and pharmacotherapy in direct costs, and the costs of absenteeism, presenteeism, and premature mortality in indirect costs, are included.

RESULTS

Total costs of smoking in the Czech Republic in 2019 are estimated as 2110.6 million EUR (0.94% of GDP). Direct costs amounted to 537.0 million EUR (2.9% of health expenditures in 2019) and indirect costs were 1573.6 million EUR, mainly driven by the costs of premature mortality (1062.5 million EUR).

CONCLUSIONS

Despite the declining trend in the prevalence of smoking in the Czech Republic, the associated costs are considerable. Investments into strategies to reduce smoking continue to be needed.

Explaining presenteeism behaviour with the theory of planned behaviour - a longitudinal study

PURPOSE

This study uses the Theory of Planned Behaviour (TPB) to explore presenteeism, where individuals work despite being ill. The research seeks to understand how attitudes, subjective norms, and perceived behavioural control are associated with presenteeism behaviours.

METHODS

A longitudinal design was employed, involving 2814 employees from 16 companies. Data were collected using a survey on two measurement points, which included validated scales and vignettes to assess attitudes toward presenteeism. The data were analysed using cluster analysis and a linear mixed effects regression to evaluate the TPB model.

RESULTS

Three clusters of attitudes toward presenteeism were identified through cluster analysis. The model explained 27.8% of the variance in the fixed effects and 52.6% in the combined fixed and random effects. The regression model found associations between presenteeism and factors such as quantitative demands, work-privacy conflict, and leadership culture. Attitudes towards presenteeism were a strong predictor, with specific clusters showing differing propensities to work while ill.

CONCLUSION

The study confirms the suitability of the TPB in explaining presenteeism. It highlights the importance of individual attitudes, subjective norms, and perceived behavioural control in shaping presenteeism. The findings suggest that promoting a health-supportive workplace culture, including open communication about illness, might reduce presenteeism.

Translation and Psychometric Testing of the Hägerbäumer Presenteeism Scale in English

PURPOSE

Interest in presenteeism has increased in research. Presenteeism is a behaviour of going to work despite illness. It has been predominantly measured using single items, which introduce limitations to validity. To overcome these limitations, Hägerbäumer developed a German multi-item presenteeism scale.

METHODS

The aim of the study was to provide an English translation and psychometric testing of the scale. This was conducted in two phases with native English-speaking employed adults. Phase 1 includes translation and cognitive debriefing, phase 2 testing construct validity and internal consistency reliability.

RESULTS

Cognitive debriefing with 10 employees revealed no problems with understanding or answering the translated items. In total, 487 employed adults participated in the study, of which data from 287 were included in the analysis. For structural validity, the goodness-of-fit indicators all reached their thresholds (TLI = 0.98, CFI = 0.99, RMSEA = 0.07, SRMR = 0.02). The scale does not show differences between sexes and age groups but between sectors (F6,70.95 = 5.53, p < 0.001). The internal consistency reliability was satisfactory with α = 0.89 (CI 95%, 0.87-0.91).

CONCLUSION

The translated multidimensional scale for measuring presenteeism at the behavioural level demonstrated good psychometric properties in an initial validation. Further psychometric testing is required before using this scale in cross-national comparison in research and international companies.

Quantifying value loss due to presenteeism and absenteeism in workers' compensation spinal patients

Background

Recent studies suggest that better outcomes in work productivity following spine surgery eventually offset the higher cost of treatment. By analyzing preoperative and postoperative changes in work productivity, studies can determine if surgery is cost-effective and give patients valuable information about treatment. Prior studies reviewing outcomes in work performance after spine surgery have largely excluded patients on workers' compensation from the overall cost analysis.

Methods

A retrospective review of 92 eligible patients was conducted. Evaluation of the EHR identified presenteeism and absenteeism from designated work restrictions. Statistical analyses were conducted using JMP Pro 17.

Results

About 84 (83%) spinal surgery cases were able to return to work, 60 (59%) were able to return to work with no restrictions, 26 (26%) received permanent work restrictions, and 12 (12%) were still undergoing treatment. 86 (85%) experienced presenteeism and 99 (98%) experienced absenteeism. Of the cases that were able to return to work without permanent work restrictions, the mean presenteeism length postoperatively was 287.4 days (median 191 days) and the mean absenteeism length postoperatively was 232.5 days (median 142 days). 72 patients were identified as having sedentary or nonsedentary labor. After excluding outliers, the average return-to-work length was 988.62 days for patients with sedentary employment types and 952.15 days for patients with nonsedentary employment types (p=.116).

Conclusion

Following spinal surgery, our worker's compensation patient population's return-to-work rate was at an average of 232.5 days (median of 142 days) for 83% of patients included in this study. This exhibited worse outcomes than a previous study's measurement excluding worker's compensation patients. Presenteeism length within our population contributed more to decreased work productivity postoperatively than absenteeism length. Our results found no significant difference in return-to-work length between patients with sedentary and nonsedentary employment types.

Factors of presenteeism and its association with detrimental effects among employees in Switzerland working in different sectors - a cross-sectional study using a multi-item instrument

PURPOSE

Presenteeism, the phenomenon of employees working despite illness, is a significant issue globally, impacting individual well-being and organizational efficiency. This study examines presenteeism among Swiss employees, exploring its occurrence, primary factors, reasons, and impact on employees' health.

METHODS

This study used cross-sectional data from 1,521 employees in different sectors in Switzerland. Descriptive statistics and multiple linear models for influencing factors and detrimental effects, such as burnout symptoms, job satisfaction, general health, and quality of life, were calculated for data analysis. Presenteeism was measured using the Hägerbäumer multi-item scale, ranging from 1 = "Never in case of illness" - 5 = "Very often in case of illness."

RESULTS

The employees reported that in case of illness, they rarely worked in the last 12 months M = 2.04 (SD = 1.00). A positive approach to presenteeism in the team was associated with less presenteeism (β = -0.07) and problematic leadership culture in dealing with presenteeism with increased presenteeism (β = 0.10). In addition to well-known factors, presenteeism was significant for burnout symptoms (β = 1.49), general health status (β = -1.5), and quality of life (β = -0.01).

CONCLUSION

The study offers insights into the phenomenon of presenteeism among Swiss employees in various sectors by applying a multi-item scale for presenteeism. The findings indicate that a positive team dynamic and organizational culture may significantly reduce presenteeism. Presenteeism behavior is a significant factor of adverse outcomes. This highlights the importance of acknowledging presenteeism in the context of occupational health.

Prevalence of sickness presenteeism and associated factors among primary school teachers in Gondar city, northwest Ethiopia

Background

Sickness presenteeism, the phenomenon of people going to work despite being ill, is an occupational and psychosocial condition that hurts both the health of workers and organizational productivity. It negatively affects health, increases health-related costs, and the risk of contagious diseases. Primary school teachers are particularly vulnerable to this problem, although little is known about its scope and associated factors. This study aimed to determine the prevalence and factors associated with sickness presenteeism among school teachers in Northwest Ethiopia.

Methods

An institution-based cross-sectional study was employed and the study period was from April 18 to May 18, 2023. A sample of 633 primary school teachers was recruited using two-stage stratified random sampling. Data were collected using structured self-administered questionnaires. Epi-data version 4.6 and STATA version 14 were used for data entry and analysis, respectively. Binary logistic regression analysis was used. A multivariable logistic regression model with an adjusted odds ratio was fitted for statistical significance.

Results

A total of 603 school teachers participated in this study, with a response rate of 95.26%. The overall prevalence of sickness presenteeism in the last 12 months was 54.7% (N = 330) [95% CI (50.9, 58.7)]. Private school teachers [AOR: 2.21, 95% CI (1.14, 4.28)], low supervisor support [AOR: 1.53, 95% CI (1.06, 2.20)], lack of staff replacement availability [AOR: 2.74, 95% CI (1.85, 4.06)], low colleague support [AOR: 2.17, 95% CI (1.40, 3.37)], unsuitable household conditions [AOR: 1.49, 95% CI (1.08, 2.34)], and strict attendance control [AOR: 2.54, 95% CI (1.67, 3.85)] were factors significantly associated with sickness presenteeism.

Conclusion

The prevalence of sickness presenteeism was relatively high among primary school teachers because of factors such as low support from supervisors and colleagues, strict attendance control, lack of staff replacement, unsuitable household conditions, and private school type. Strategies to promote teachers' health include fostering a culture of support and collaboration among colleagues, recruiting adequate staff, and implementing liberal attendance policies.

Work ability and return-to-work of patients with post-COVID-19: a systematic review and meta-analysis

BACKGROUND

In addition to several sequelae of post-COVID-19, individuals also experience significant limitations in work ability, resulting in negative consequences for the return-to-work (RTW) process. This systematic review and meta-analysis were conducted to assess the impact of post-COVID-19 on work ability and RTW of individuals previously infected with SARS-CoV-2.

METHODS

Studies on the work ability and RTW of patients with post-COVID-19 (more than 12 weeks after an acute SARS-CoV-2 infection) were regarded eligible for inclusion. Systematic search of literature was performed up to March 2023 using five databases (MEDLINE, EMBASE, CINAHL, CENTRAL and WHO COVID 19). Study selection followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) Statement. A meta-analysis estimated the overall success rate of RTW. The risk of bias of the included studies was evaluated with the Newcastle Ottawa Scale (NOS).

RESULTS

19 relevant studies, published between 2021 and 2023, were included in the systematic review, involving 21.155 patients from 14 different countries. The findings indicate that a significant proportion of individuals with post-COVID-19 experience persistent symptoms and functional impairments, with fatigue being the most prominent symptom. These persistent symptoms can have a considerable (negative) impact on individuals' physical and psychological capacity to participate in work-related activities, leading to lower work ability and increased absenteeism. The RTW for post-COVID-19 patients is complex, with approximately 60.9% of patients successfully returning to work after 12 or more weeks following SARS-CoV-2 infection. Among those who successfully returning to work, a considerable number need modifications in their work duties or hours to cope with residual impairments. Factors such as workplace accommodations, supportive policies, and occupational rehabilitation programs play a crucial role in facilitating successful RTW.

CONCLUSIONS

The systematic review underscores the substantial impact of post-COVID-19 on work-related outcomes. The implications of this research highlight the need for healthcare providers, employers, and policymakers to collaborate in creating inclusive work environments and implementing tailored rehabilitation programs to support individuals recovering from post-COVID-19. Further research should focus on long-term follow-up studies with mixed methods to gain a more comprehensive understanding of the long-term consequences of post-COVID-19 on work ability and RTW outcomes.

PROSPERO REGISTRATION NUMBER

CRD42023385436.

Supervised Exercise Therapy Reduces Presenteeism to Greater Extent Than Unsupervised Self-Care in Workers with Musculoskeletal Pain: a Systematic Review and Meta-Analysis

PURPOSE

Presenteeism is defined as the loss of work productivity due to health issues in workers, which can be measured subjectively. This study aimed to compare the effectiveness of supervised exercise therapy and unsupervised self-care in reducing presenteeism in workers with musculoskeletal disorders.

METHODS

PubMed, Embase, and Cochrane Library were searched for various keywords from their inception to January 2023. Two examiners independently assessed the eligibility of studies: (1) studies involving workers suffering from musculoskeletal pain, (2) those involving supervised exercise therapy intervention with interactive communication, and (3) those in which the comparison group was subjected to interventions other than supervised exercise therapy, and (4) those including patient-reported outcome measures of presenteeism or work productivity or ability. Standardized mean differences (SMD) were calculated using a random effects model, with higher scores indicating reduced presenteeism in the intervention group compared with that in the comparison group. The GRADE assesses the overall certainty of the evidence.

RESULTS

Only the short-term effects of interventions on presenteeism could be obtained using four studies. The intervention group showed statistically significant short-term effects on presenteeism compared with the comparison group (p < 0.001; SMD, 0.52; 95% confidence interval, 0.27-0.77). The GRADE score was downgraded by two levels from high to low due to concerns for indirectness.

CONCLUSIONS

Although the certainty of the evidence was low, it was assumed that supervised exercise therapy was more effective than unsupervised self-care in reducing presenteeism in workers with musculoskeletal disorders.

Regional impact assessment of air quality improvement: The air quality lifecourse assessment tool (AQ-LAT) for the West Midlands combined authority (WMCA)

Poor air quality is the largest environmental health risk in England. In the West Midlands, UK, ∼2.9 million people are affected by air pollution with an average loss in life expectancy of up to 6 months. The 2021 Environment Act established a legal framework for local authorities in England to develop regional air quality plans, generating a policy need for predictive environmental impact assessment tools. In this context, we developed a novel Air Quality Lifecourse Assessment Tool (AQ-LAT) to estimate electoral ward-level impacts of PM2.5 and NO2 exposure on outcomes of interest to local authorities, namely morbidity (asthma, coronary heart disease (CHD), stroke, lung cancer), mortality, and associated healthcare costs. We apply the Tool to assess the health economic burden of air pollutant exposure and estimate benefits that would be generated by meeting WHO 2021 Global Air Quality Guidelines (AQGs) (annual average concentrations) for NO2 (10 μg/m3) and PM2.5 (5 μg/m3) in the West Midlands Combined Authority Area. All West Midlands residents live in areas which exceed WHO AQGs, with 2070 deaths, 2070 asthma diagnoses, 770 CHD diagnoses, 170 lung cancers and 650 strokes attributable to air pollution exposure annually. Reducing PM2.5 and NO2 concentrations to WHO AQGs would save 10,700 lives reducing regional mortality by 1.8%, gaining 92,000 quality-adjusted life years (QALYs), and preventing 20,500 asthma, 7400 CHD, 1400 lung cancer, and 5700 stroke diagnoses, with economic benefits of £3.2 billion over 20 years. Significantly, we estimate 30% of QALY gains relate to reduced disease burden. The AQ-LAT has major potential to be replicated across local authorities in England and applied to inform regional investment decisions.

Multicomponent Exercise Program to Avoid Productivity Loss Due to COVID-19

Objective:

To evaluate and quantify the mitigation of productivity deficits in individuals recovering from post-COVID-19 conditions by implementing a multicomponent exercise program (MEP).

Methods:

Thirty-nine post-COVID-19 patients meeting specific criteria participated in a 7-week intervention program involving cycloergometer interval training, strength exercises, and respiratory physiotherapy. Follow-up assessments occurred 2 weeks post-intervention and 23 months later via telephone interviews. The study computed the average avoided loss of productivity to estimate indirect costs.

Results:

Over 2 years, 51.4% had persistent symptoms and 48.7% reported complex issues. Age differences were observed between retired and employed individuals. Multinomial regression revealed a 91.849 times higher likelihood of simple signs in employed individuals and a 1.579 times higher likelihood of being older in retirees. Simple symptoms were associated with a 90 000 times higher likelihood of returning to work. Sensitivity analysis indicated potential productivity gains from €117 955 to €134 004 per patient over a 4-year horizon.

Conclusion:

The MEP is a safe and effective post-COVID recovery intervention, notably aiding workforce reintegration for individuals with simple signs. Patients with such signs were significantly more likely to return to work, highlighting potential productivity gains and emphasizing the need for further research on the program's cost-effectiveness and broader societal benefits.

Examining how well economic evaluations capture the value of mental health

Health economics evidence informs health-care decision making, but the field has historically paid insufficient attention to mental health. Economic evaluations in health should define an appropriate scope for benefits and costs and how to value them. This Health Policy provides an overview of these processes and considers to what extent they capture the value of mental health. We suggest that although current practices are both transparent and justifiable, they have distinct limitations from the perspective of mental health. Most social value judgements, such as the exclusion of interindividual outcomes and intersectoral costs, diminish the value of improving mental health, and this reduction in value might be disproportionate compared with other types of health. Economic analyses might have disadvantaged interventions that improve mental health compared with physical health, but research is required to test the size of such differential effects and any subsequent effect on decision-making systems such as health technology assessment systems. Collaboration between health economics and the mental health sciences is crucial for achieving mental-physical health parity in evaluative frameworks and, ultimately, improving population mental health.

Psychometric properties of the Korean version of the Stanford Presenteeism Scale in a nurse population

Presenteeism, which refers to going to work despite being ill, has been associated with loss of work productivity, decreased quality of care, and an increased risk of health problems. The prevalence of presenteeism is particularly high among nurses; therefore, a reliable and valid tool is needed to assess presenteeism. This study aimed to translate the Stanford Presenteeism Scale (SPS) and to examine its psychometric properties in a Korean nurse population. A methodological study was performed in January 2023. The original SPS-6 (English-language) was translated and adapted to the Korean language using a committee approach translation, cognitive interviews, and content validation with a review panel of experts. An online survey was completed by 608 Korean nurses. The internal consistency, item-to-total correlation, construct validity, concurrent validity, and discriminant validity were examined as psychometric properties of the Korean version of the SPS. The final version of the K-SPS consists of four items shortened from the original six items. Cronbach's alpha of the K-SPS-4 was 0.74, indicating adequate reliability. Confirmatory factor analysis showed a one-factor solution with a good fit. There was a positive correlation between the K-SPS-4 and the Work Limitations Questionnaire. Discriminant validity was evidenced by the positive correlation of the K-SPS-4 with job satisfaction and the negative correlation with job stress. The K-SPS-4 has acceptable psychometric properties, supporting the feasibility of its use in assessing the level of presenteeism among Korean nurses. The validated K-SPS-4 can provide a basis for developing intervention programs to enhance productivity and promote health among nurses in clinical settings.

Work-related musculoskeletal pain among physical therapists: a cross-sectional study in Kyoto and Shiga prefectures, Japan

OBJECTIVES

This study aimed to determine the actual working conditions and prevalence of musculoskeletal pain among physical therapists in Japan, and the risk factors associated with low back pain (LBP) and upper limb pain (ULP).

METHODS

A cross-sectional study of physical therapists in the Kyoto and Shiga prefectures was conducted using a self-administered questionnaire. The survey contents included questions regarding personal, work-related, and musculoskeletal pain factors. Logistic regression models were used to analyze factors associated with LBP and ULP.

RESULTS

Responses from 1479 participants were included in the analyses. The prevalence of LBP at the time of the survey and in the past year was 40.1% and 74.3% in females, and 37.8% and 69.9% in males, respectively. The prevalence of ULP was 34.8% and 64.2% in females, and 27.2% and 53.3% in males. The numbers of patients who performed manual therapy per day, worked using a fixed-height bed, performed manual therapy, had job dissatisfaction and stress, were over 40 years old, and slept less than 6 hours were associated with LBP and ULP. Assistance task was a risk factor only for LBP, and female sex a risk factor only for ULP.

CONCLUSIONS

The prevalence of LBP and ULP among physical therapists in Japan was as high as that in nurses and care workers. Work-related factors associated with LBP and ULP were identified among physical therapists. Thus, to prevent work-related musculoskeletal disorders, measures to reduce the physical burden from the perspective of occupational health are required.

A prospective cohort study of presenteeism and increased risk of unemployment among Japanese workers during the COVID-19 pandemic

OBJECTIVES

Presenteeism adversely affects workers' quality of life, leading to further deterioration of their health and affecting their ability to continue working. Unemployment is one of the most serious consequences for workers experiencing presenteeism. A worker's ability to work depends on the degree of mismatch between their health status and job demands and work factors. The COVID-19 pandemic has affected workers' experiences of presenteeism as well as their employment status. We examined the association between presenteeism and risk of job resignations and unemployment among Japanese workers during the COVID-19 pandemic.

METHODS

A prospective study of 27 036 internet monitors was conducted, starting in December 2020, with 18 560 (68.7%) participating in the follow-up by December 2021. The Work Functioning Impairment Scale (WFun) was used to measure the degree of work function impairment.

RESULTS

The group with the highest WFun scores had higher odds ratios (ORs) for both retirement and unemployment for health reasons than the group with the lowest WFun scores. ORs were 2.99 (95% CI, 2.48-3.62; P < .001) and 1.82 (95% CI, 1.65-2.00; P < .001), respectively.

CONCLUSIONS

Workers with work functioning impairment are at increased risk of resignation or unemployment. Management strategies for workers with work functioning impairment are needed to reduce their disadvantages in employment.

Do worksite health promotion programs (WHPP) influence presenteeism among employees? A systematic review1

BACKGROUND

Worksite health promotion programs (WHPP) aiming to reduce presenteeism are rapidly increasing. However, program-efficacy seems impaired by lack of conceptual understanding and theoretical frameworks related to presenteeism.

OBJECTIVES

To study (1) the concept of presenteeism, (2) the causes of the phenomenon and (3) which WHPP affect presenteeism.

METHODS

We followed the PRISMA 2020 guidelines for mapping relevant literature in seven databases. The main search-terms were "worksite", "WHPP", "presenteeism", "employee productivity" and "interventions". Reviews and review of reviews were included and analysed according to research questions and ecological theory.

RESULTS

Of 2196 studies identified, 14 reviews were included, comprising 1390 single studies. Conceptually, presenteeism was poorly defined, mostly related to productivity/performance limitations due to ill health. Factors causing presenteeism addressed individual health or lifestyle (78%), and, to a lesser extent work and organisational factors (management/job stress) (22%). Forty-five highly diverse WHPP were identified, about 90% focusing health outcomes. 22/45 WHPP affected presenteeism/productivity positively. Multi-component WHPP implemented at multi levels accounted for 55%. Single-component programs, implemented at individual level, were mostly targeting health-risk subgroups. No specific WHPP seems preferable. Methodological quality seems highly associated with worksite intervention-efficacy.

CONCLUSION

Increased telework opportunities due to COVID-19 experiences has affected working conditions worldwide, for better and worse, requiring adaptions at employee, management, organisational and socio-cultural levels. Our results showed high program diversity, several adaptable to future needs (e.g., digital solutions), however hampered by narrow focus on individual health. Future research should focus on theory-based high quality multilevel WHPP comprising contextual, work, and organisational factors.

Presenteeism and Low Work Performance Among Fruit Farm Workers in Northeast Brazil

OBJECTIVES

The "decision" to go to work, or remain absent, when unwell undermines worker energy. I is therefore understandable that low work performance is one of the main consequences of the act of presenteeism. This study evaluated the association between presenteeism, and absolute and relative work performance among fruit farm workers in Northeast Brazil.

METHODS

A cross-sectional study investigated 340 paid employees of both sexes, aged 18 years or over, who worked during the 2019 irrigated fruit harvest in the municipality of Petrolina, Northeast Brazil. Absolute and relative work performance were measured using the Health and Work Performance Questionnaire. Workers who answered "one or more days" to the question "How many days have you worked this season when you were injured or unwell?" were considered presenteeists. Poisson regression with robust variance models was used to estimate the prevalence ratios of the main associations, adjusted for potential confounders.

RESULTS

Presenteeist workers presented lower absolute and relative work performance than non-presenteeist workers according to the strata for most of the investigated factors. The associations between presenteeism, and absolute (adjusted prevalence ratio = 1.31) and relative work performance (adjusted prevalence ratio = 1.45) remained strong, even after multiple adjustments for other relevant variables.

CONCLUSION

Presenteeist fruit culture workers self-assessed their work performance as lower than non-presenteeist ones.

Treatment Delay in Patients Undergoing Headache Surgery (Nerve Decompression Surgery)

Background

Although headache surgery has been shown to be an effective treatment option for refractory headache disorders, it has not been included as part of the headache disorder management algorithm by non-surgical providers. This study aims to evaluate the delay in surgical management of patients with headache disorders. In addition, a cost comparison analysis between conservative and operative treatment of headache disorders was performed, and the surgical outcomes of headache surgery were reported.

Methods

Among 1112 patients who were screened, 271 (56%) patients underwent headache surgery. Data regarding the onset of headache disorder and pre- and postoperative pain characteristics were prospectively collected. To perform a cost comparison analysis, direct and indirect costs associated with the conservative treatment of headache disorders were calculated.

Results

The median duration between onset of headache disorder symptoms and headache surgery was 20 (8.2-32) years. The annual mean cost of conservative treatment of headache disorders was $49,463.78 ($30,933.87-$66,553.70) per patient. Over the 20-year time period before surgery, the mean cost was $989,275.65 ($618,677.31-$1,331,073.99). In comparison, the mean cost of headache surgery was $11,000. The median pain days per month decreased by 16 (0-25) (p<0.001), the median pain intensity reduced by 4 (2-7) (p<0.001), and the median pain duration decreased by 11 hours (0-22) (p<0.001).

Conclusion

This study shows that patients experience symptoms of headache disorders for an average of 20 years prior to undergoing headache surgery. Surgical treatment not only significantly improves headache pain but also reduces healthcare costs and should be implemented in the management algorithm of headache disorders.

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.

Extent and predictors of presenteeism among healthcare professionals working in Swiss hospitals, nursing homes and home care organizations

Presenteeism can have negative impacts on employees' health and organizational productivity. It occurs more often among occupations with high attendance demands, such as healthcare professionals. Information is lacking regarding the extent to which presenteeism differs between disciplines and settings in the health sector and what the reasons are for presenteeism as well as influencing factors. This study used cross-sectional data on 15,185 healthcare professionals (nursing staff, midwives, physicians, medical-technical and medical-therapeutic professionals) from various settings (acute care, rehabilitation or psychiatric hospitals, nursing homes and home care organizations). Presenteeism was measured by examining how many days participants had gone to work despite feeling sick during the past 12 months. Kruskal-Wallis was used to test for significant differences between healthcare professions/settings and regression analysis to identify significant predictors of presenteeism. Nursing assistants with a formal education reported the most days of presenteeism in the past 12 months (mean = 4.3, SD = 12.0). Healthcare professionals working in nursing homes reported the most days of presenteeism in the past 12 months (mean = 4.2, SD = 8.7). The majority of healthcare professionals had been present at work while being ill due to a sense of duty (83.7%), followed by consideration for colleagues and/or managers (76.5%). In particular, the psychiatric hospitals (β = 0.139; p < 0.001), nursing homes (β = 0.168; p < 0.001) and home care organizations (β = 0.092; p < 0.001), as well as the language regions of Swiss French (β = - 0.304; p < 0.001) and Italian (β = - 0.154; p < 0.001), were significantly associated with presenteeism. Presenteeism differs between disciplines and settings in the health sector. The reasons for presenteeism and its influencing factors in the health sector are mostly consistent with those in other sectors. Cultural differences should be afforded greater relevance in future presenteeism research.

Risk factors for school-based presenteeism in children: a systematic review

INTRODUCTION

Children attending school whilst unwell, known as school-based presenteeism, results in negative impacts on education and mental and physical health. We aimed to identify the risk factors for this behaviour.

METHOD

We conducted a systematic search of five databases (11 July 2022) using words associated with school (e.g., school and childcare) and presenteeism (e.g., presenteeism and sick leave). The studies are synthesised according to the risk factors associated with school-based presenteeism and are grouped into themes by related topics.

RESULTS

Our review included 18 studies, with quantitative, qualitative, and mixed-method study designs. Children, parents, and school staff reported past incidents and intentions for future presenteeism. We identified five themes from these reports: perceptions about the illness / signs and symptom(s); children's characteristics; children's and parents' motivations and attitudes towards school; organisational factors; and school sickness policy. Increased risk of school-based presenteeism was commonly linked to symptoms that were perceived low in severity and unidentifiable, children with a high school absence record, disbelief in children's illness, unsupportive employers, vague school policies and financial consequences.

CONCLUSIONS

School-based presenteeism is complex due to the competing interests of the multiple individuals involved, such as children, parents, and school staff. Sickness policies need to include clear and specific guidance about illness and the signs and symptoms of diseases and should be communicated to all relevant individuals to mitigate against discrepancies in how the policy is interpreted. Furthermore, parents and school staff need support, such as financial and childcare, to be able to manage children when they are unwell.

Health care utilizations and costs of Campylobacter enteritis in Germany: A claims data analysis

OBJECTIVE

The number of reported cases of Campylobacter enteritis (CE) remains on a high level in many parts of the world. The aim of this study was to analyze the health care utilizations and direct and indirect costs of CE and sequelae of patients insured by a large health insurance with 26 million members in Germany.

METHODS

Claims data of insurants with at least one CE diagnosis in 2017 (n = 13,150) were provided, of which 9,945 were included in the analysis of health care utilizations and costs. If medical services were not diagnosis-linked, CE-associated costs were estimated in comparison to up to three healthy controls per CE patient. Indirect costs were calculated by multiplying the work incapacities by the average labor costs. Total costs of CE in Germany were extrapolated by including all officially reported CE cases in 2017 using Monte Carlo simulations.

RESULTS

Insurants showed a lower rate of 56 CE diagnoses per 100,000 than German surveillance data for 2017, but with a similar age, gender and regional distribution. Of those CE cases, 6.3% developed post-infectious reactive arthritis, Guillain-Barré syndrome (GBS), inflammatory bowel disease (IBD) and/or irritable bowel syndrome (IBS). Health care utilizations differed depending on CE severity, age and gender. Average CE-specific costs per patient receiving outpatient care were € 524 (95% CI 495-560) over a 12-month period, whereas costs per hospitalized CE case amounted to € 2,830 (2,769-2,905). The analyzed partial costs of sequelae ranged between € 221 (IBS) and € 22,721 (GBS) per patient per 12 months. Total costs of CE and sequelae extrapolated to Germany 2017 ranged between € 74.25 and € 95.19 million, of which 10-30% were due to sequelae.

CONCLUSION

CE is associated with a substantial economic burden in Germany, also due to care-intensive long-lasting sequelae. However, uncertainties remain as to the causal relationship of IBD and IBS after CE.

Cost consequence analysis of waiting for lumbar disc herniation surgery

The economic repercussions of waiting for lumbar disc surgery have not been well studied. The primary goal of this study was to perform a cost-consequence analysis of patients receiving early vs late surgery for symptomatic disc herniation from a societal perspective. Secondarily, we compared patient factors and patient-reported outcomes. This is a retrospective analysis of prospectively collected data from the CSORN registry. A cost-consequence analysis was performed where direct and indirect costs were compared, and different outcomes were listed separately. Comparisons were made on an observational cohort of patients receiving surgery less than 60 days after consent (short wait) or 60 days or more after consent (long wait). This study included 493 patients with surgery between January 2015 and October 2021 with 272 patients (55.2%) in the short wait group and 221 patients (44.8%) classified as long wait. There was no difference in proportions of patients who returned to work at 3 and 12-months. Time from surgery to return to work was similar between both groups (34.0 vs 34.9 days, p = 0.804). Time from consent to return to work was longer in the longer wait group corresponding to an additional $11,753.10 mean indirect cost per patient. The short wait group showed increased healthcare usage at 3 months with more emergency department visits (52.6% vs 25.0%, p < 0.032), more physiotherapy (84.6% vs 72.0%, p < 0.001) and more MRI (65.2% vs 41.4%, p < 0.043). This corresponded to an additional direct cost of $518.21 per patient. Secondarily, the short wait group had higher baseline NRS leg, ODI, and lower EQ5D and PCS. The long wait group had more patients with symptoms over 2 years duration (57.6% vs 34.1%, p < 0.001). A higher proportion of patients reached MCID in terms of NRS leg pain at 3-month follow up in the short wait group (84.0% vs 75.9%, p < 0.040). This cost-consequence analysis of an observational cohort showed decreased costs associated with early surgery of $11,234.89 per patient when compared to late surgery for lumbar disc herniation. The early surgery group had more severe symptoms with higher healthcare utilization. This is counterbalanced by the additional productivity loss in the long wait group, which likely have a more chronic disease. From a societal economic perspective, early surgery seems beneficial and should be promoted.

A scoping review of digital workplace wellness interventions in low- and middle-income countries

INTRODUCTION

Digital technology-based interventions have gained popularity over the last two decades, due to the ease with which they are scalable and low in implementation cost. Multicomponent health promotion programmes, with significant digital components, are increasingly being deployed in the workplace to assess and promote employees' health behaviours and reduce risk of chronic diseases. However, little is known about workplace digital health interventions in low- and middle- income countries (LMICs).

METHODS

Various combinations of keywords related to "digital health", "intervention", "workplace" and "developing country" were applied in Ovid MEDLINE, EMBASE, CINAHL Plus, PsycINFO, Scopus and Cochrane Library for peer-reviewed articles in English language. Manual searches were performed to supplement the database search. The screening process was conducted in two phases and a narrative synthesis to summarise the data. The review protocol was written prior to undertaking the review (OSF Registry:10.17605/OSF.IO/QPR9J).

RESULTS

The search strategy identified 10,298 publications, of which 24 were included. Included studies employed the following study designs: randomized-controlled trials (RCTs) (n = 12), quasi-experimental (n = 4), pilot studies (n = 4), pre-post studies (n = 2) and cohort studies (n = 2). Most of the studies reported positive feedback of the use of digital wellness interventions in workplace settings.

CONCLUSIONS

This review is the first to map and describe the impact of digital wellness interventions in the workplace in LMICs. Only a small number of studies met the inclusion criteria. Modest evidence was found that digital workplace wellness interventions were feasible, cost-effective, and acceptable. However, long-term, and consistent effects were not found, and further studies are needed to provide more evidence. This scoping review identified multiple digital health interventions in LMIC workplace settings and highlighted a few important research gaps.

Reduced Immune Fitness and Job Performance: Absenteeism, Presenteeism, and Associated Costs for the Dutch Economy

Reduced immune fitness can have a significant negative impact on work performance. The aim of the current study was to evaluate the impact of reduced immune fitness on job performance and associated costs for the Dutch economy. Data from n = 425 Dutch working adults (18-65 years old) who completed an online survey were analyzed to evaluate the number of days of absenteeism (not going to work) and presenteeism (working while sick) due to reduced immune fitness, and the performance level on days worked with reduced immune fitness. Data from for the year 2019 were analyzed. Participants reported 2.9 absenteeism days and 19 presenteeism days, with an average performance reduction of 22.8% when working on days with reduced immune fitness. Significantly more days of absenteeism and presenteeism were reported by women, individuals with a poorer immune fitness, and those with underlying disease. Performance impairment on days worked while experiencing reduced immune fitness was significantly greater among individuals with a younger age at the junior career level, those with underlying disease, and among highly educated individuals. The associated costs of reduced immune fitness were estimated at €4.3 billion for absenteeism and €6.4 billion for presenteeism. Together, the costs of reduced immune fitness for the Dutch economy in 2019 were estimated at €10.7 billion. These findings demonstrate that reduced immune fitness has a significant negative impact on the Dutch economy.

Cultural Adaptation and Validation of the Health and Work Performance Questionnaire in German

BACKGROUND

Research interest in presenteeism as a productivity loss has grown given its estimated costs for organizations. To enable researchers in German-speaking countries to compare their findings internationally, a validated German Health and Work Performance Questionnaire (HPQ) version is needed.

METHODS

First, the HPQ was translated from English into German, culturally adapted, and tested using cognitive debriefing in interviews. Second, the structural validity of the item measuring presenteeism as productivity loss was tested.

RESULTS

Overall, 14 problems with items were identified in the cognitive debriefing. Of these, 57% were comprehension problems. Two of three alternative hypotheses for discriminative validity were accepted. No discrimination was possible for individuals with or without chronic disease.

CONCLUSIONS

The German HPQ has satisfactory cross-cultural validity and can be used to measure overall performance, as well as presenteeism in a specified sample with health problems.

Presenteeism in Non-Academic Staff in a Public University Context: Prevalence, Associated Factors, and Reasons to Work While Sick during the COVID-19 Pandemic

Presenteeism negatively affects worker performance. We aimed to know the prevalence of presenteeism in non-academic university staff, identify health problems and associated factors, as well as explore the reasons that led to presenteeism during the COVID-19 pandemic. A cross-sectional study was conducted with a convenience sample of 332 non-academic staff. The Portuguese version of the Stanford Presenteeism Scale (SPS-6) was used, and socio-demographic and occupational data were collected. Participants were divided into groups according to the presenteeism cut-off score (no presenteeists, presenteeists with high job performance, presenteeists with low job performance). Multinomial regression was used to identify occupational and demographic characteristics associated with presenteeism. An open question replies analysis made it possible to explore the reasons for going to work while sick. Presenteeism was experienced by 30.1%. Presenteeism with high job performance was not associated with socio-demographic and work factors. Professionals who performed only physical work (OR = 9.4; 95% CI: 1.7; 51.0) and those who conducted hybrid work (OR = 4.1; 95% CI: 1.8; 9.6) showed a higher risk of belonging to the presenteeist group with low job performance. Financial reasons led professionals to work while sick. This study raises the importance of evaluating presenteeism in non-academic staff to create conditions for them to maintain high performance despite presenteeism and to intervene when there is low performance due to presenteeism.

The mediating role of general and cognitive stress on the effect of an app-based intervention on productivity measures in workers: A randomized controlled trial (Preprint)

BACKGROUND

Loss of productivity is a result of absence from work (absenteeism) or of working with limitations due to illness (presenteeism). Recently, occupational mental health interventions have increasingly been delivered in digital format, as this is thought to be more convenient, flexible, easily accessible, and anonymous. However, the effectiveness of electronic mental health (e-mental health) interventions in the workplace to improve presenteeism and absenteeism remains unknown, and could be potentially mediated by psychological variables such as stress levels.

OBJECTIVE

The aim of this study was to determine the effectiveness of an e-mental health intervention to reduce absenteeism and presenteeism in employees, as well as to investigate the mediating role of stress in this effect.

METHODS

Employees of six companies in two countries participated in a randomized controlled trial (n=210 in the intervention group and n=322 in the waitlist control group). Participants in the intervention group could use the Kelaa Mental Resilience app for 4 weeks. All participants were asked to complete assessments at baseline, during the intervention, postintervention, and at a 2-week follow-up. Absenteeism and presenteeism were assessed by means of the Work Productivity and Activity Impairment Questionnaire: General Health, while general and cognitive stress were assessed through the Copenhagen Psychosocial Questionnaire-Revised Version. Regression and mediation analyses were performed to evaluate the effect of the Kelaa Mental Resilience app on presenteeism and absenteeism.

RESULTS

The intervention did not have a direct effect on presenteeism or absenteeism, neither at postintervention nor at follow-up. Nevertheless, general stress significantly mediated the intervention effect on presenteeism (P=.005) but not on absenteeism (P=.92), and cognitive stress mediated the effect of the intervention on both presenteeism (P<.001) and absenteeism (P=.02) right after the intervention. At the 2-week follow-up, the mediating effect of cognitive stress on presenteeism was significant (P=.04), although this was not the case for its mediating effect on absenteeism (P=.36). Additionally, at the 2-week follow-up, general stress did not mediate the intervention effect on presenteeism (P=.25) or on absenteeism (P=.72).

CONCLUSIONS

While no direct effect of the e-mental health intervention on productivity was found in this study, our findings suggest that stress reduction could mediate the effect of the intervention on presenteeism and absenteeism. As such, e-mental health interventions that address stress in employees might also indirectly reduce presenteeism and absenteeism in these employees. However, due to study limitations such as an overrepresentation of female participants in the sample and a high proportion of attrition, these results should be interpreted with caution. Future research is needed to better understand the mechanisms of interventions on productivity in the workplace.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05924542; https://clinicaltrials.gov/study/NCT05924542.

Sickness Presenteeism among Employees Having Workplace Conflicts-Results from Pooled Analyses in Latvia

The study's objective was to investigate the associations between workplace conflicts and self-reported sickness presenteeism defined as going to work while being ill. Cross-sectional survey data pooled from four national surveys in years 2006, 2010, 2013 and 2018 with a study sample of 6368 employees (mean age 42.9 years and 52.9% females) were used. Respondents were randomly drawn from different regions and industries; therefore, the sample is representative of the working population of Latvia. The computer-assisted personal interviewing (CAPI) method was used to collect data at respondents' places of residence. The associations between conflicts in the workplace and presenteeism were analyzed by using binomial logistic regression and calculated as odds ratios (ORs) with 95% confidence intervals (CIs) adjusted (aOR) for gender, age, education, and survey year. On average, 11% of respondents reported sickness presenteeism during the last year. The odds of presenteeism significantly increased for all types of workplace conflicts, but most for conflicts with managers (OR = 2.84). The odds of presenteeism doubled for those reporting conflicts with other employees (OR = 2.19) and conflicts with customers (OR = 1.85). The odds of sickness presenteeism were significantly higher if the workplace conflicts occurred often (seven times for conflicts between managers and employees, and four times for conflicts with customers) and with other employees. Presenteeism frequency increased more than three times if respondents had more than two types of conflict at work. The results of this study show that having any type of conflict in the workplace significantly increases the frequency of sickness presenteeism, especially when conflicts are frequent or an employee has more types of conflicts in the workplace. The study results justify the need to implement targeted and effective workplace conflict management measures at the organizational level to decrease sickness presenteeism.

Cost of Health-Related Work Productivity Loss among Fly-In Fly-Out Mining Workers in Australia

Sufficient knowledge on the work productivity impact of the health of fly-in fly-out (FIFO) workers in the mining sector in Australia is lacking. This study examined the impact of health and lifestyle behaviours on the work productivity of FIFO workers in the mining industry in Australia. FIFO workers completed an online questionnaire on health and work productivity loss measures. Linear regressions were used to model annual work productivity losses through absenteeism, presenteeism and total productivity loss. Workers with a high risk for health conditions were, on average, associated with 3.87% more productivity loss (absenteeism: 1.27% and presenteeism: 2.88%) than those with low risk. Workers who had multiple health risks classified as medium (3-4 health conditions) and high (5 or more health conditions) reported 1.75% and 7.46% more total productivity loss, respectively, than those with fewer multiple health risks (0-2 health conditions). Health conditions were estimated to account for an annual additional productivity cost due to absenteeism of AUD 8.82 million, presenteeism of AUD 14.08 million and a total productivity loss of AUD 20.96 million per 1000 workers. FIFO workers with high health risks experience more absenteeism, presenteeism and overall productivity loss. These measures provide strong economic justifications that could support the need for targeted workplace health interventions.

Treatment-resistant depression and major depression with suicide risk-The cost of illness and burden of disease

Introduction

Treatment-Resistant Depression (TRD) and Major Depression with Suicide Risk (MDSR) are types of depression with relevant effects on the health of the population and a potentially significant economic impact. This study estimates the burden of disease and the costs of illness attributed to Treatment-Resistant Depression and Major Depression with Suicide Risk in Portugal.

Methods

The disease burden for adults was quantified in 2017 using the Disability-Adjusted Life Years (DALYs) lost. Direct costs related to the health care system and indirect costs were estimated for 2017, with indirect costs resulting from the reduction in productivity. Estimates were based on multiple sources of information, including the National Epidemiological Study on Mental Health, the Hospital Morbidity Database, data from the Portuguese National Statistics Institute on population and causes of death, official data on wages, statistics on the pharmaceutical market, and qualified opinions of experts.

Results

The estimated prevalence of TRD, MDSR, and both types of depression combined was 79.4 thousand, 52.5 thousand, and 11.3 thousand patients, respectively. The disease burden (DALY) due to the disability generated by TRD alone, MDSR alone, and the joint prevalence was 25.2 thousand, 21 thousand, and 4.5 thousand, respectively, totaling 50.7 thousand DALYs. The disease burden due to premature death by suicide was 15.6 thousand DALYs. The estimated total disease burden was 66.3 thousand DALYs. In 2017, the annual direct costs with TRD and MDSR were estimated at € 30.8 million, with the most important components being medical appointments and medication. The estimated indirect costs were much higher than the direct costs. Adding work productivity losses due to reduced employment, absenteeism, presenteeism, and premature death, a total cost of € 1.1 billion was obtained.

Conclusions

Although TRD and MDSR represent relatively small direct costs for the health system, they have a relevant disease burden and extremely substantial productivity costs for the Portuguese economy and society, making TRD and MDSR priority areas for achieving health gains.

Validity and Reliability of the Persian Version of the Sedentary Behavior Questionnaire Among Office Employees

Purpose: This study aimed to evaluate the validity and reliability of the Persian version of the sedentary behavior questionnaire (SBQ) among university office employees in Kermanshah province in the west of Iran.Method: A validation study was performed among 701 university office employees in Kermanshah province. The content validation process was conducted using interviews with content and lay experts. The intraclass correlation coefficient (ICC) was calculated as test-retest reliability. In addition, exploratory and confirmatory factor analyses were used to assess the validity of the questionnaire structure.Results: The scale content validity indices using two general agreement approaches and the mean approach were 88.88 and 97.77%, respectively. The ICC was estimated at 1.00 [95% CI:0.99, 1.00]. The exploratory factor analyses suggested nine-factor solutions, and in the independent sample, the confirmatory factor analysis fit indices showed that the model had an acceptable fit to the data.Conclusion: The Persian version of the SBQ had acceptable reliability and validity for assessing SBs among office employees. This questionnaire is a simple and self-report tool for measuring SB in daily life and would be useful in the design and evaluation of preventive programs among administrative staff and high-risk population surveillance.

Incorporating productivity loss in health economic evaluations: a review of guidelines and practices worldwide for research agenda in China

Introduction

Productivity loss may contribute to a large proportion of costs of health conditions in an economic evaluation from a societal perspective, but there is currently a lack of methodological consensus on how productivity loss should be measured and valued. Despite the research progress surrounding this issue in other countries, it has been rarely discussed in China.

Methods

We reviewed the official guidelines on economic evaluations in different countries and regions and screened the literature to summarise the extent to which productivity loss was incorporated in economic evaluations and the underlying methodological challenges.

Results

A total of 48 guidelines from 46 countries/regions were included. Although 32 (67%) guidelines recommend excluding productivity loss in the base case analysis, 23 (48%) guidelines recommend including productivity loss in the base case or additional analyses. Through a review of systematic reviews and the economic evaluation studies included in these reviews, we found that the average probability of incorporating productivity loss in an economic evaluation was 10.2%. Among the economic evaluations (n=478) that explicitly considered productivity loss, most (n=455) considered losses from paid work, while only a few studies (n=23) considered unpaid work losses. Recognising the existing methodological challenges and the specific context of China, we proposed a practical research agenda and a disease list for progress on this topic, including the development of the disease list comprehensively consisting of health conditions where the productivity loss should be incorporated into economic evaluations.

Conclusion

An increasing number of guidelines recommend the inclusion of productivity loss in the base case or additional analyses of economic evaluation. We optimistically expect that more Chinese researchers notice the importance of incorporating productivity loss in economic evaluations and anticipate guidelines that may be suitable for Chinese practitioners and decision-makers that facilitate the advancement of research on productivity loss measurement and valuation.

High Impact of Pediatric Inflammatory Bowel Disease on Caregivers' Work Productivity and Daily Activities: An International Prospective Study

OBJECTIVES

To evaluate the longitudinal evolution of work productivity loss and activity impairment in caregivers of children with inflammatory bowel disease (IBD). We also evaluated the associations between these impairments, IBD-related factors, and caregivers' health-related quality of life (HRQOL) and estimated the indirect costs related to work absenteeism.

STUDY DESIGN

Since January 2017, children with newly diagnosed IBD were enrolled prospectively in the Pediatric Inflammatory Bowel Disease Network for Safety, Efficacy, Treatment and Quality improvement of care study. The impact of pediatric-onset IBD on caregivers' socioeconomic functioning (work and daily activities) and HRQOL was assessed using the Work Productivity and Activity Impairment for caregivers questionnaire and the European Quality of Life Five Dimension Five Level questionnaire, at diagnosis and 3 and 12 months of age. Generalized estimating equation models were applied to evaluate outcomes longitudinally, adjusted for IBD type, disease activity, and child's age at diagnosis.

RESULTS

Up to July 2021, 491 children with IBD were eligible for analysis of caregivers' Work Productivity and Activity Impairment questionnaire. At diagnosis, the mean caregivers' employment rate was 78.4%; the adjusted mean work productivity loss was 44.6% (95% CI, 40.2%-49.0%), and the adjusted mean activity impairment was 34.3% (95% CI, 30.8%-37.7%). Work productivity loss and activity impairment significantly decreased over time and were associated with disease activity, but not with IBD type or child's age. Caregivers' HRQOL was associated with both impairments. Costs related to work absenteeism were at least €6272 ($7276) per patient during the first year after diagnosis.

CONCLUSIONS

Caregivers of children with IBD experience significant impairments in work and daily activities, especially at diagnosis. The impact decreases thereafter and is associated with disease activity and caregivers' HRQOL. Work absenteeism results in high indirect costs.

A systematic review on the economic burden of interstitial lung disease and the cost-effectiveness of current therapies

Background

The economic burden of interstitial lung disease (ILD) is unknown, limiting informed resource allocation and planning. We sought to conduct the first systematic review on the direct, indirect, and overall costs associated with ILD and to evaluate the cost-effectiveness of current therapies globally.

Methods

We conducted systematic reviews of ILD disease cost studies and cost-effectiveness analyses (CEAs) using MEDLINE, Embase, and Web of Science databases between 2000 and 2020. We compared ILD costs between countries according to the share of costs towards each country’s respective gross domestic product (GDP) per capita. Costs are reported in 2020 USD.

Results

We identified 25 disease cost studies and 7 CEAs. The direct medical costs ranged between $1824 and $116,927 annually per patient (median $32,834; 14–180% of GDP per capita in Western countries). The leading drivers of direct costs were inpatient (55%), outpatient (22%), and medication costs (18%), based on pooled estimates. Annual indirect costs ranged from $7149 to $10,902 per employed patient (median $9607; 12–23% of GDP per capita). Among the 7 CEAs, only 1 study (14%) showed an ILD therapy (ambulatory oxygen) was cost-effective compared to best supportive care.

Conclusion

The direct and indirect costs associated with ILD are consistently high in all countries with available data, with cost-effectiveness profiles of new therapies generally undesirable. Globally, the median total direct cost for ILD equates to 51% of a country’s GDP per capita and has been increasing over time.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12890-022-01922-2.

Study protocol of EMPOWER: A cluster randomized trial of a multimodal eHealth intervention for promoting mental health in the workplace following a stepped wedge trial design

Objective: This article describes the EMPOWER study, a controlled trial aiming to determine the effectiveness and cost-effectiveness of an eHealth intervention to prevent common health problems and reduce presenteeism and absenteeism in the workplace. Intervention: The EMPOWER intervention spans universal, secondary and tertiary prevention and consists of an eHealth platform delivered via a website and a smartphone app designed to guide employees throughout different modules according to their specific profiles. Design: A stepped-wedge cluster randomized trial will be implemented in four countries (Finland, Poland, Spain and UK) with employees from small and medium enterprises (SMEs) and public agencies. Companies will be randomly allocated in one of three groups with different times at which the intervention is implemented. The intervention will last 7 weeks. Employees will answer several questionnaires at baseline, pre- and post-intervention and follow-up. Outcome measures: The main outcome is presenteeism. Secondary outcomes include depression, anxiety, insomnia, stress levels, wellbeing and absenteeism. Analyses will be conducted at the individual level using the intention-to-treat approach and mixed models. Additional analyses will evaluate the intervention effects according to gender, country or type of company. Cost-effectiveness and cost-utility analyses [based on the use of quality-adjusted life-years (QALYS)] will consider a societal, employers' and employees' perspective.

Workplace productivity loss as a result of absenteeism and presenteeism in chronic and episodic migraine: a scoping review

Purpose

Migraine consists of a chronic neurological disorder with episodic attacks. Migraine prevails in people of their most productive working age, followed by difficulties at work and social functions. This scoping review aims to analyze the economic burden on a workplace due to chronic migraine compared to episodic migraine by focusing on the indirect costs of absenteeism and presenteeism and addressing the research gaps in this field.

Design/methodology/approach

According to the PRISMA Extension for Scoping Reviews, a comprehensive electronic literature search was carried out from 2010 to 2020 using the Google Scholar and Medline/PubMed databases.

Findings

The findings confirm that chronic and episodic migraine harm the workplace's productivity, escalating with the frequency of migraine attacks. Differences occur between presenteeism and absenteeism rates among chronic and episodic migraine, and higher presenteeism than absenteeism rates.

Originality/value

This review sheds new light on the indirect burden of migraine. It shows the gaps in the explored research area and the need for more targeted and extended research that could provide a deeper understanding of the workplace's hidden costs of migraine. The issues discussed are important as they can raise awareness of the interested parties, policymakers, employers and vocational rehabilitation specialists on the work disability associated with migraine.

Factors Influencing Intention to Work while Ill: A Systematic Review

OBJECTIVES

The aim of this systematic review was to identify factors influencing workers' intention to work while ill, using the Theory of Planned Behavior (TPB) as a theoretical framework.

METHODS

A systematic search of articles was carried out from PubMed, Scopus, and Web of Science databases. Eligibility of each article was assessed using PRISMA guidelines. Overall, 22 articles met the inclusion criteria after the selection process and were included in this review.

RESULTS

The factors fit into 3 constructs: (1) attitude (good and bad consequences of working while ill), (2) subjective norms (descriptive and injunctive norms on working while ill), and (3) perceived behavioral control (facilitators and barriers of working while ill).

CONCLUSIONS

The TPB is a practical theory to conceptualize and understand the factors influencing workers' intention to work while ill. These findings provide initial knowledge on the development of a framework to measure workers' intention to work while ill and to propose appropriate interventions for workers with chronic illness.

Measurement Instruments of Productivity Loss of Paid and Unpaid Work: A Systematic Review and Assessment of Suitability for Health Economic Evaluations From a Societal Perspective

OBJECTIVES

This study aimed (1) to perform a systematic literature review of instruments for measuring productivity loss of paid and unpaid work and (2) to assess the suitability (in terms of identification, measurement, and valuation) of these instruments for use in health economic evaluations from a societal perspective.

METHODS

Articles published from 2018 were sourced from PubMed/Medline, PsycInfo, Embase, and Econlit. Using 2 separate search strategies, eligible economic evaluations and validation studies were selected and unique measurement instruments identified. A data-extraction form was developed by studying previous literature and consulting an international panel of experts in the field of productivity costs. This data-extraction form was applied to assess the suitability of instruments for use in economic evaluations.

RESULTS

A total of 5982 articles were retrieved from the databases, of which 99 economic evaluations and 9 validation studies were included in the review. A total of 42 unique measurement instruments were identified. Nine instruments provided quantified measures of absenteeism, presenteeism, and unpaid work. Five instruments supplied the necessary information to enable the use of at least 1 common valuation method. The Health and Labour Questionnaire-Short Form, Health and Labour Questionnaire, and Institute for Medical Technology Assessment Productivity Cost Questionnaire met both criteria. Nevertheless, the developers replaced the Health and Labour Questionnaire-Short Form and Health and Labour Questionnaire by the more recently developed Institute for Medical Technology Assessment Productivity Cost Questionnaire.

CONCLUSIONS

Although many instruments for measuring productivity loss were identified, most were not suitable for capturing productivity changes for economic evaluations from a societal perspective. Future research can benefit from this study by making an informed instrument choice for the measurement of productivity loss of paid and unpaid work.

A systematic literature review of burden of illness in adults with uncontrolled moderate/severe asthma

BACKGROUND

There are limited published data on the burden of moderate/severe uncontrolled asthma.

METHODS

We conducted a systematic literature review to better understand the impact of moderate-to-severe asthma in the US, the UK, Germany, France, Italy, Spain, Canada, Japan, and Australia in terms of prevalence, clinical measures, health-related quality of life (HRQoL) and economic burden, for patients whose asthma is uncontrolled despite inhaled corticosteroid/long-acting β₂-agonist (ICS/LABA) therapy.

RESULTS

The prevalence of uncontrolled asthma among patients with moderate/severe disease varied but was as high as 100% in some subgroups. Patients with uncontrolled asthma generally had poor lung function (mean/median pre-bronchodilator forced expiratory volume in 1 second [FEV₁]: 1.69-2.45 L; mean/median pre-bronchodilator percent predicted FEV₁: 57.2-79.7). There was also a substantial but variable exacerbation burden associated with uncontrolled asthma, with the annualised rate of exacerbations ranging from 1.30 to 7.30 when considering various patient subgroups. Furthermore, the annualised rate of severe exacerbations ranged from 1.66 to 3.60. The HRQoL burden measured using disease-specific and generic instruments consistently demonstrated substantial impairment of HRQoL for those with uncontrolled asthma; Asthma Quality of Life Questionnaire scores ranged from 3.00 to 5.20, whilst EurQol-5 Dimensions index scores ranged from 0.53 to 0.59. Direct, indirect and total costs together with consumption of other healthcare resources associated with managing uncontrolled asthma were also substantial in the population studied; no caregiver burden was identified.

CONCLUSIONS

Our findings suggest that significant unmet needs exist for patients with uncontrolled asthma despite the availability of ICS/LABA therapy. Novel treatments are needed to help reduce the burden to patients, healthcare systems and society.

Effectiveness of a Healthy Lifestyle Program (HeLP) for low back pain: statistical analysis plan for a randomised controlled trial

BACKGROUND

This paper describes the statistical analysis plan for a randomised controlled trial of a Healthy Lifestyle Program (HeLP) for low back pain targeting multiple health risks and behaviours, weight, physical activity, diet and smoking, to improve disability. We describe the methods for the main analyses and economic analysis of the trial.

METHODS AND DESIGN

The trial is a two-arm pragmatic randomised controlled trial comparing the effect of the HeLP intervention to usual care on low back pain disability at 26 weeks. A total of 346 adults with low back pain were recruited from the Newcastle and Hunter region between September 2017 and November 2019 and randomised to either HeLP or usual care. HeLP is a 6-month intervention with participant outcomes measured at weeks 6, 12, 26 and 52 post randomisation. This statistical analysis plan describes data integrity, handling and preparation of data for analyses and methods for analyses. The primary endpoint for the trial is disability at 26 weeks using the 24-item self-report Roland Morris Disability Questionnaire. The primary analysis will follow the intention-to-treat principle using linear mixed regression models.

DISCUSSION

The statistical analysis plan for this trial was produced to reduce outcome reporting bias arising from knowledge of the study findings. Any deviations will be described and justified in the final report.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12617001288314 . Registered on 6 September 2017.

Economic evaluation in psychiatric pharmacogenomics: a systematic review

Nowadays, many relevant drug-gene associations have been discovered, but pharmacogenomics (PGx)-guided treatment needs to be cost-effective as well as clinically beneficial to be incorporated into standard health care. To address current challenges, this systematic review provides an update regarding previously published studies, which assessed the cost-effectiveness of PGx testing for the prescription of antidepressants and antipsychotics. From a total of 1159 studies initially identified by literature database querying, and after manual assessment and curation of all of them, a mere 18 studies met our inclusion criteria. Of the 18 studies evaluations, 16 studies (88.89%) drew conclusions in favor of PGx testing, of which 9 (50%) genome-guided interventions were cost-effective and 7 (38.9%) were less costly compared to standard treatment based on cost analysis. More precisely, supportive evidence exists for CYP2D6 and CYP2C19 drug-gene associations and for combinatorial PGx panels, but evidence is limited for many other drug-gene combinations. Amongst the limitations of the field are the unclear explanation of perspective and cost inputs, as well as the underreporting of study design elements, which can influence though the economic evaluation. Overall, the findings of this article demonstrate that although there is growing evidence on the cost-effectiveness of genome-guided interventions in psychiatric diseases, there is still a need for performing additional research on economic evaluations of PGx implementation with an emphasis on psychiatric disorders.

Proposal of layered mental healthcare for mental well-being

A new concept, 'Layered mental healthcare' for keeping employees mental well-being in the workplace to avoid losses caused by both absenteeism and presenteeism is proposed. A key factor forming the basis of the concept is the biometric measurements over three layers, i.e., behaviour, physiology, and brain layers, for monitoring mental/distress conditions of employees. Here, the necessity of measurements in three layers was validated by the data-driven approach using the preliminary dataset measured in the office environment. Biometric measurements were supported by an activity tracker, a PC logger, and the optical topography; mental/distress conditions were quantified by the brief job stress questionnaire. The biometric features obtained 1 week before the measurement of mental/distress scores were selected for the best regression model. The feature importance of each layer was obtained in the learning process of the best model using the light graded boosting machine and was compared between layers. The ratio of feature importance of behaviour:physiology:brain layers was found to be 4:3:3. The study results suggest the contribution and necessity of the three-layer features in predicting mental/distress scores.

Interpretation of trial-based economic evaluations of musculoskeletal physical therapy interventions

BACKGROUND

As resources for healthcare are scarce, decision-makers increasingly rely on economic evaluations when making reimbursement decisions about new health technologies, such as drugs, procedures, devices, and equipment. Economic evaluations compare the costs and effects of two or more interventions. Musculoskeletal disorders have a high prevalence and result in high levels of disability and high costs worldwide. Because physical therapy interventions are usually the first line of treatment for musculoskeletal disorders, economic evaluations of such interventions are becoming increasingly important for stakeholders in the field of physical therapy, including physical therapists, decision-makers, and reseachers. However, economic evaluations are relatively difficult to interpret for the majority of stakeholders.

OBJECTIVE

To support physical therapists, decision-makers, and researchers in the field of physical therapy interpreting trial-based economic evaluations and translating the results of such studies to clinical practice.

METHODS

The design, analysis, and interpretation of economic evaluations performed alongside randomized controlled trials are discussed. To further illustrate and explain these concepts, we use a case study assessing the cost-effectiveness of exercise therapy compared to standard advice in patients with musculoskeletal disorders.

CONCLUSIONS

Economic evaluations are increasingly being used in healthcare decision-making. Therefore, it is of utmost importance that their design, conduct, and analysis are state-of-the-art and that their interpretation is adequate. This masterclass will help physical therapists, decision-makers, and researchers in the field of physical therapy to critically appraise the quality and results of trial-based economic evaluations and to apply the results of such studies to their own clinical practice and setting.