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PharmacoEconomics
Published in: PharmacoEconomics 7/2013

01-07-2013 | Practical Application

Productivity Costs in Economic Evaluations: Past, Present, Future

Authors: Marieke Krol, Werner Brouwer, Frans Rutten

Published in: PharmacoEconomics | Issue 7/2013

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Abstract

Productivity costs occur when the productivity of individuals is affected by illness, treatment, disability or premature death. The objective of this paper was to review past and current developments related to the inclusion, identification, measurement and valuation of productivity costs in economic evaluations. The main debates in the theory and practice of economic evaluations of health technologies described in this review have centred on the questions of whether and how to include productivity costs, especially productivity costs related to paid work. The past few decades have seen important progress in this area. There are important sources of productivity costs other than absenteeism (e.g. presenteeism and multiplier effects in co-workers), but their exact influence on costs remains unclear. Different measurement instruments have been developed over the years, but which instrument provides the most accurate estimates has not been established. Several valuation approaches have been proposed. While empirical research suggests that productivity costs are best included in the cost side of the cost-effectiveness ratio, the jury is still out regarding whether the human capital approach or the friction cost approach is the most appropriate valuation method to do so. Despite the progress and the substantial amount of scientific research, a consensus has not been reached on either the inclusion of productivity costs in economic evaluations or the methods used to produce productivity cost estimates. Such a lack of consensus has likely contributed to ignoring productivity costs in actual economic evaluations and is reflected in variations in national health economic guidelines. Further research is needed to lessen the controversy regarding the estimation of health-related productivity costs. More standardization would increase the comparability and credibility of economic evaluations taking a societal perspective.
Footnotes
1
This review generally focuses on issues regarding productivity cost estimation in economic evaluations conducted to inform (national) decision makers regarding the relative cost effectiveness of new health interventions. Some of the topics discussed may therefore not fully relate to, for instance, the US healthcare system, where employers are significant purchasers of healthcare.
 
2
Note that the inclusion of productivity costs does not necessarily lower cost-effectiveness estimates or favour interventions for productive individuals [17‐20].
 
3
Whether it is relevant to include potential effects on future productivity depends on the valuation approach. If the friction cost approach is adopted, these costs normally need not be included, since they will commonly fall beyond the friction period. Their inclusion is important, however, when using the human capital approach.
 
4
Valuation approaches are further discussed in Sect. 5 of this review.
 
5
Obviously, the term productivity costs is less appropriate if lost productivity is valued in terms of effects instead of costs.
 
Literature
1.
Claxton K, Paulden M, Gravelle H, Brouwer W, Culyer AJ. Discounting and decision making in the economic evaluation of health-care technologies. Health Econ. 2011;20(1):2–15.PubMedCrossRef
2.
Claxton K, Walker S, Palmer S, Sculpher M. Appropriate perspectives for health care decisions (CHE research paper no. 54). New York: Centre for Health Economics; 2010.
3.
Jonsson B. Ten arguments for a societal perspective in the economic evaluation of medical innovations. Eur J Health Econ. 2009;10(4):357–9.PubMedCrossRef
4.
Johannesson M, Jönsson B, Jönsson L, Kobelt G, Zethraeus N. Why should economic evaluations of medical innovations have a societal perspective? OHE briefing. 2009;51:1–32.
5.
Hirth RA, Chernew ME, Miller E, Fendrick AM, Weissert WG. Willingness to pay for a quality-adjusted life year: in search of a standard. Med Decis Making. 2000;20(3):332–42.
6.
Shiroiwa T, Sung YK, Fukuda T, Lang HC, Bae SC, Tsutani K. International survey on willingness-to-pay (WTP) for one additional QALY gained: what is the threshold of cost effectiveness? Health Econ. 2010;19(4):422–37.
7.
Bobinac A, van Exel NJ, Rutten FF, Brouwer WB. GET MORE, PAY MORE? An elaborate test of construct validity of willingness to pay per QALY estimates obtained through contingent valuation. J Health Econ. 2012;31(1):158–68.PubMedCrossRef
8.
Brouwer WB, Koopmanschap MA, Rutten FF. Productivity costs in cost-effectiveness analysis: numerator or denominator—a further discussion. Health Econ. 1997;6(5):511–4.
9.
Zhang W, Bansback N, Anis AH. Measuring and valuing productivity loss due to poor health: a critical review. Soc Sci Med. 2011;72(2):185–92.PubMedCrossRef
10.
11.
Olsen J, Richardson J. Production gains from health care: what should be included in cost-effectiveness analysis. Soc Sci Med. 1999;49:17–26.PubMedCrossRef
12.
Johannesson M. A note on the depreciation of the societal perspective in economic evaluation of health care. Health Policy. 1995;33(1):59–66.PubMedCrossRef
13.
Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press; 2005.
14.
Gold M, Siegel J, Russell L, Weinstein M. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.
15.
Brouwer WBF, Exel JA, Baltussen RMPM, Rutten FFH. A dollar is a dollar-or is it? Value Health. 2006;9(5):341–7.PubMedCrossRef
16.
Lindholm L, Lofroth E, Rosen M. Does productivity influence priority setting? A case study from the field of CVD prevention. Cost Eff Resour Alloc. 2008;17(6):6.CrossRef
17.
Pritchard C, Sculpher M. Productivity costs: principles and practice in economic evaluation. London: Office of Health Economics; 2000.
18.
Koopmanschap MA, Rutten FF. The impact of indirect costs on outcomes of health care programs. Health Econ. 1994;3(6):385–93.
19.
Krol M, Papenburg J, Koopmanschap M, Brouwer W. Do productivity costs matter? The impact of including productivity costs on the incremental costs of interventions targeted at depressive disorders. Pharmacoeconomics. 2011;29(7):601–19.PubMed
20.
21.
Brooks A, Hagen SE, Sathyanarayanan S, Schultz AB, Edington DW. Presenteeism: critical issues. J Occup Environ Med. 2010;52(11):1055–67.PubMedCrossRef
22.
Koopmanschap MA, Rutten FF, van Ineveld BM, van Roijen L. The friction cost method for measuring indirect costs of disease. J Health Econ. 1995;14(2):171–89.PubMedCrossRef
23.
Brouwer WB, Koopmanschap MA, Rutten FF. Productivity losses without absence: measurement validation and empirical evidence. Health Policy. 1999;48(1):13–27.PubMedCrossRef
24.
Posnett J, Jan S. Indirect cost in economic evaluation: the opportunity cost of unpaid inputs. Health Econ. 1996;5(1):13–23.
25.
Brouwer WB, van Exel NJ, Koopmanschap MA, Rutten FF. Productivity costs before and after absence from work: as important as common? Health Policy. 2002;61(2):173–187.
26.
Pauly MV, Nicholson S, Xu J, Polsky D, Danzon PM, Murray JF, et al. A general model of the impact of absenteeism on employers and employees. Health Econ. 2002;11(3):221–31.PubMedCrossRef
27.
Nicholson S, Pauly MV, Polsky D, Sharda C, Szrek H, Berger ML. Measuring the effects of work loss on productivity with team production. Health Econ. 2006;15(2):111–23.PubMedCrossRef
28.
Pauly MV, Nicholson S, Polsky D, Berger ML, Sharda C. Valuing reductions in on-the-job illness: ‘presenteeism’ from managerial and economic perspectives. Health Econ. 2008;17(4):469–85.PubMedCrossRef
29.
Severens JL, Laheij RJ, Jansen JB, Van der Lisdonk EH, Verbeek AL. Estimating the cost of lost productivity in dyspepsia. Aliment Pharmacol Ther. 1998;12(9):919–23.PubMedCrossRef
30.
Koopmanschap M, Burdorf A, Jacob K, Meerding WJ, Brouwer W, Severens H. Measuring productivity changes in economic evaluation: setting the research agenda. Pharmacoeconomics. 2005;23(1):47–54.PubMedCrossRef
31.
Prasad M, Wahlqvist P, Shikiar R, Shih YC. A review of self-report instruments measuring health-related work productivity: a patient-reported outcomes perspective. Pharmacoeconomics. 2004;22(4):225–44.PubMedCrossRef
32.
Mattke S, Balakrishnan A, Bergamo G, Newberry SJ. A review of methods to measure health-related productivity loss. Am J Manag Care. 2007;13(4):211–7.PubMed
33.
Lofland JH, Pizzi L, Frick KD. A review of health-related workplace productivity loss instruments. Pharmacoeconomics. 2004;22(3):165–84.PubMedCrossRef
34.
Brouwer WB, Meerding WJ, Lamers LM, Severens JL. The relationship between productivity and health-related QOL: an exploration. Pharmacoeconomics. 2005;23(3):209–18.PubMedCrossRef
35.
Lamers LM, Meerding WJ, Severens JL, Brouwer WB. The relationship between productivity and health-related quality of life: an empirical exploration in persons with low back pain. Qual Life Res. 2005;14(3):805–13.PubMedCrossRef
36.
37.
Nyman J. Productivity costs revisited: toward a new US policy. Health Econ. 2012;21(12):1387–401.CrossRef
38.
Koopmanschap MA, Rutten FF. Indirect costs in economic studies: confronting the confusion. Pharmacoeconomics. 1993;4(6):446–54.PubMedCrossRef
39.
Weinstein MC, Siegel JE, Garber AM, Lipscomb J, Luce BR, Manning WG Jr, et al. Productivity costs, time costs and health-related quality of life: a response to the Erasmus Group. Health Econ. 1997;6(5):505–10.
40.
Brouwer WB, Koopmanschap MA, Rutten FF. Productivity costs measurement through quality of life? A response to the recommendation of the Washington Panel. Health Econ. 1997;6(3):253–9.
41.
Tranmer JE, Guerriere DN, Ungar WJ, Coyte PC. Valuing patient and caregiver time: a review of the literature. Pharmacoeconomics. 2005;23(5):449–59.PubMedCrossRef
42.
Koopmanschap MA, Rutten FFH, van Ineveld BM, van Roijen L. Reply to Johanneson’s and Karlsson’s comment. J Health Econ. 1997;16:257–9.CrossRef
43.
Johannesson M, Karlsson G. The friction cost method: a comment. J Health Econ. 1997;16(2):249–55 (discussion 257–9).
44.
Brouwer WB, Koopmanschap MA. The friction-cost method: replacement for nothing and leisure for free? Pharmacoeconomics. 2005;23(2):105–11.PubMedCrossRef
45.
Meltzer D, Weckerle C, Chang L. Do people consider financial effects in answering quality of life questions? Med Decis Making. 1999;19:517.CrossRef
46.
Myers J, McCabe S, Gohmann S. Quality-of-life assessment when there is a loss of income. Med Decis Making. 2007;27(1):27–33.
47.
Richardson J, Peacock SJ, Iezzi A. Do quality-adjusted life years take account of lost income? Evidence from an Australian survey. Eur J Health Econ. 2009;10(1):103–9.PubMedCrossRef
48.
Davidson T, Levin LA. Do individuals consider expected income when valuing health states? Int J Technol Assess Health Care. 2008;24(4):488–94.PubMedCrossRef
49.
Sendi P, Brouwer WB. Is silence golden? A test of the incorporation of the effects of ill-health on income and leisure in health state valuations. Health Econ. 2005;14(6):643–7.PubMedCrossRef
50.
Krol M, Brouwer W, Sendi P. Productivity costs in health-state valuations: does explicit instruction matter? Pharmacoeconomics. 2006;24(4):401–14.PubMedCrossRef
51.
Krol M, Sendi P, Brouwer W. Breaking the silence: exploring the potential effects of explicit instructions on incorporating income and leisure in TTO exercises. Value Health. 2009;12(1):172–80.PubMedCrossRef
52.
Brouwer WB, Grootenboer S, Sendi P. The incorporation of income and leisure in health state valuations when the measure is silent: an empirical inquiry into the sound of silence. Med Decis Making. 2009;29(4):503–12.
53.
Brouwer WB, Rutten FF. The missing link: on the line between C and E. Health Econ. 2003;12(8):629–36.PubMedCrossRef
54.
Culyer AJ, Bombard Y. An equity framework for health technology assessments. Making: Med Decis.; 2011.
55.
Brouwer WB, Rutten FF. Health economics: a bridge over troubled water. Eur J Public Health. 2001;11(2):234–6.PubMedCrossRef
56.
Belgian Health Care Knowledge Centre. Guidelines for pharmacoeconomic evaluations in Belgium (KCE reports 78C). Brussels: KCE; 2008.
57.
National Institute for Health and Clinical Excellence. Guide to the methods of technology appraisal. London: NICE; 2008.
58.
Edling A, Stenberg A. General guidelines for economic evaluations from the Pharmaceutical Benefits Board. Stockholm: Pharmaceutical Benefits Board; 2003.
59.
College voor zorgverzekeringen. Guidelines for pharmacoeconomic research, updated version. Diemen: CVZ; 2006.
60.
Capri S, Ceci A, Terranova L, Merlo F, Mantovani L. Guidelines for economic evaluations in Italy: recommendations from the Italian group of pharmacoeconomic studies. Drug Inf J. 2001;35:189–201.
61.
Norwegian Medicines Agency. Norwegian guidelines for pharmacoeconomic analysis in connection with applications for reimbursement. Oslo: Norwegian Medicines Agency; 2002.
62.
Jacob-Tacken KH, Koopmanschap MA, Meerding WJ, Severens JL. Correcting for compensating mechanisms related to productivity costs in economic evaluations of health care programmes. Health Econ. 2005;14(5):435–43.PubMedCrossRef
63.
Krol M, Brouwer W, Severens JL, Kaper J, Evers S. Productivity cost calculations: correcting for compensation mechanisms and multiplier effects? Soc Sci Med. 2012;75(11):1981–8.PubMedCrossRef
64.
65.
Meerding WJ, IJzelenberg W, Koopmanschap MA, Severens JL, Burdorf A. Health problems lead to considerable productivity loss at work among workers with high physical load jobs. J Clin Epidemiol. 2005;58(5):517–23.PubMedCrossRef
66.
Zhang W, Gignac MA, Beaton D, Tang K, Anis AH, Canadian Arthritis Network Work Productivity Group. Productivity loss due to presenteeism among patients with arthritis: estimates from 4 instruments. J Rheumatol. 2010;37(9):1805–14.PubMedCrossRef
67.
van Roijen L, Essink-Bot ML, Koopmanschap MA, Bonsel G, Rutten FF. Labor and health status in economic evaluation of health care. The Health and Labor Questionnaire. Int J Technol Assess Health Care. 1996;12(3):405–15.
68.
Zhang W, Bansback N, Boonen A, Severens JL, Anis AH. Development of a composite questionnaire, the valuation of lost productivity, to value productivity losses: application in rheumatoid arthritis. Value Health. 2012;15(1):46–54.PubMedCrossRef
69.
Reid M. Economics of household production. New York: Wiley; 1934.
70.
Stone PW, Chapman RH, Sandberg EA, Liljas B, Neumann PJ. Measuring costs in cost-utility analyses. Variations in the literature. Int J Technol Assess Health Care. 2000;16(1):111–24.PubMedCrossRef
71.
Gerard K. Cost-utility in practice: a policy maker’s guide to the state of the art. Health Policy. 1992;21(3):249–79.PubMedCrossRef
72.
Weisbrod BA. The valuation of human capital. J Polit Econ. 1961;69(5):425–36.CrossRef
73.
Koopmanschap MA, van Ineveld BM. Towards a new approach for estimating indirect costs of disease. Soc Sci Med. 1992;34(9):1005–10.PubMedCrossRef
74.
Koopmanschap MA, Rutten FF, van Ineveld BM, van Roijen L. The friction cost method for measuring indirect costs of disease. J Health Econ. 1995;14(2):171–89.PubMedCrossRef
75.
76.
Johannesson M. Avoiding double-counting in pharmacoeconomic studies. Pharmacoeconomics. 1997;11(5):385–8.PubMedCrossRef
77.
Meltzer D, Johannesson M. Inconsistencies in the “societal perspective” on costs of the Panel on Cost-Effectiveness in Health and Medicine. Med Decis Making. 1999;19(4):371–7.
78.
Tilling C, Krol M, Tsuchiya A, Brazier J, Brouwer W. In or out? Income losses in health state valuations: a review. Value Health. 2010;13(2):298–305.
79.
Waldman JD, Kelly F, Arora S, Smith HL. The shocking cost of turnover in health care. Health Care Manage Rev. 2004;29(1):2–7.
80.
Koopmanschap MA, van Exel JN, van den Berg B, Brouwer WB. An overview of methods and applications to value informal care in economic evaluations of healthcare. Pharmacoeconomics. 2008;26(4):269–80.PubMedCrossRef
81.
van Exel J, Bobinac A, Koopmanschap M, Brouwer W. The invisible hands made visible: recognizing the value of informal care in healthcare decision-making. Expert Rev Pharmacoecon Outcomes Res. 2008;8(6):557–61.PubMedCrossRef
82.
van den Berg B, Brouwer W, van Exel J, Koopmanschap M, van den Bos GA, Rutten F. Economic valuation of informal care: lessons from the application of the opportunity costs and proxy good methods. Soc Sci Med. 2006;62(4):835–45.PubMedCrossRef
83.
van den Berg B, Al M, Brouwer W, van Exel J, Koopmanschap M. Economic valuation of informal care: the conjoint measurement method applied to informal caregiving. Soc Sci Med. 2005;61(6):1342–55.PubMedCrossRef
84.
van den Berg B, Brouwer WB, Koopmanschap MA. Economic valuation of informal care. An overview of methods and applications. Eur J Health Econ. 2004;5(1):36–45.PubMedCrossRef
85.
Brouwer WB, van Exel NJ, Koopmanschap MA, Rutten FF. The valuation of informal care in economic appraisal. A consideration of individual choice and societal costs of time. Int J Technol Assess Health Care. 1999;15(1):147–60.
86.
Grocott R, Metcalfe S, Schoeler R, Priest V, Hall C, Brougham M, et al. Prescription for pharmacoeconomic analysis: methods for cost-utility analysis. Wellington: PHARMAC Pharmaceutical Management Agency; 2007.
Metadata
Title
Productivity Costs in Economic Evaluations: Past, Present, Future
Authors
Marieke Krol
Werner Brouwer
Frans Rutten
Publication date
01-07-2013
Publisher
Springer International Publishing AG
Published in
PharmacoEconomics / Issue 7/2013
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.1007/s40273-013-0056-3

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