Many health systems are interested in the impact of disease and interventions on non-health outcomes. Over the last 10 years, work productivity has become one of the most important topics. This study was conducted to review guidelines for economic evaluations worldwide to identify how views on the types of productivity costs to be included differ across jurisdictions and to review recent trials that have measured productivity losses to identify trends and compare consistency with guidelines from different jurisdictions. The guidelines from 28 countries were evaluated and only 12 required productivity costs to be included in the main analysis or the base case analysis. Little specific guidance was provided around the types of productivity costs to be included. Correspondingly, we identified only 10 trials that explicitly measured productivity outcomes and all were conducted after the year 2001. While there was a growth in the proportion of trials evaluating biologics to measure this outcome, it showed that fewer than 50% of even recent studies failed to measure or report productivity. Furthermore, most trials did not use a standard and validated questionnaire to measure all productivity loss components. In conclusion, whether the rationale for the exclusion of productivity impacts is that healthcare budgets should only be concerned with health impacts and ignore general social welfare impacts or whether productivity impacts should be ignored to maintain generational equity or whether the methodology of productivity measurement leads to imprecise estimates, the reality is that productivity impacts are real and to ignore them is tantamount to not being fully accountable to our citizenry.
Background
Rheumatoid arthritis (RA) has a significant impact on productivity and therefore imposes a cost burden on both the public healthcare system as well as the overall economy of countries. According to reports from Canada and the UK, it was estimated that the additional cost to the economy of sick leave and work-related disability due to RA was C$2.4 billion and £1.8 billion a year, respectively . In both cases, the productivity costs attributed to RA exceeded the direct healthcare costs.
Productivity costs refer to the monetised value of the time lost due to disease or its treatment. Specifically, productivity loss is typically classified to comprise of: absenteeism – time missed from work including time lost among those still employed and those with a work history who have stopped working completely; presenteeism – impaired ability while at work; and unpaid work loss – inability to engage in daily unpaid activities. Alternatively, some would argue that besides monetary valuation, productivity loss should also be measured as an impact on quality of life. As the measurement and valuation of productivity costs are controversial, there is substantial confusion surrounding what types of productivity costs should be presented to policy makers in different jurisdictions. From a policy maker’s perspective, the importance of accurate measurement of productivity loss would seem obvious – to inform funding decisions for alternative therapeutic strategies such that productivity losses (among other goals) are minimised.
Using RA as our case study, this review seeks to overcome this confusion, and give practical suggestions to the rheumatology community in terms of how to measure and value productivity losses in future studies. We begin by describing how productivity costs can be included in economic evaluation – the primary tool policy makers use to determine whether to allocate resources to therapeutic strategies. We next review guidelines for economic evaluations worldwide to identify how views on the types of productivity costs to be included differ across jurisdictions. We finally review recent trials that have measured productivity losses to identify trends and compare consistency with guidelines from different jurisdictions.
Related posts:
Introduction to special issue of best practices in rheumatology: Health economics of musculoskeletal diseases
Access to self-management education, conservative treatment and surgery for arthritis according to socioeconomic status
Meeting the challenge of the ageing of the population: Issues in access to specialist care for arthritis
Compromised access to prescriptions and medical care because of cost among US adults with arthritis
Impact of socioeconomic gradients within and between countries on health of patients with rheumatoid arthritis (RA): Lessons from QUEST RA
The economic burden of systemic lupus erythematosus
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