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. Author manuscript; available in PMC: 2022 Dec 1.
Published in final edited form as: Am J Ind Med. 2021 Oct 22;65(11):926–939. doi: 10.1002/ajim.23302

TABLE 1.

Summary of articles included in scoping review

Study reference, industry details and occupational groups; country Type of article (peer-reviewed journal article, gray literature) Type of nonstandard work hours benefits or costs described Data source Economic estimate(s)
Coburn (1997),24 no specific industry or occupation described; United States of America Peer-reviewed journal 24-h Shiftwork, rotating shiftwork. Two main categories of costs:

  1. Health-related costs (e.g., coronary heart disease/heart attacks, motor vehicle accidents, accidental injuries and deaths at work, other medical and psychiatric illnesses)

  2. Costs of reduced productivity (e.g., manufacturing productivity, industrial accidents, employee turnover, and retraining costs)

 Information compiled from a variety of sources. Cost estimates were based on the portion of workers in shift work and the risk of outcome associated with shift work. Two main categories of costs:

  1. Health-related costs. Sources of data: National Health Care Financing Review (cost of coronary artery disease), National Safety Council (cost of accidental deaths at work; cost of smaller industrial accidents attributable to shiftworker fatigue), Shiftwork Alert Bulletin (prevalence of shiftwork). Some sources (e.g., other medical and psychiatric illnesses, risk for coronary disease associated with shiftwork) were not stated.

  2. Costs of reduced productivity. Sources of data: Census Bureau Annual Survey of Manufacturers (annual USD valued added by manufacturing industry in the United States), National Safety Council, National Transportation Safety Board (cost of truck accidents due to shiftwork), Battelle Research Labs (percent of accidents in nuclear power plants that occurred in nondaytime shifts)

 The total annual cost of shiftworker fatigue: $77 billion ($157.31 billion in 2020 dollars) Breakdown (USD per year, in billions)
  1. Increased health-related costs: $12.5
    • Coronary artery disease and heart attacks: $5.5
    • Motor vehicle accidents: $2.5
    • Accidental deaths at work: $2.5
    • Other medical and psychiatric illnesses: $2
  2. Costs of reduced human performance at work: $64.5
    • Manufacturing productivity: $50
    • Costs of industrial accidents: $13.5
    • Employee turnover and retraining costs: $1
Drebit et al. (2010),25 registered nurses; Canada Peer-reviewed journal Long work hours; overtime (>40 h/week). Overtime costs by employment category

  1. Casual

  2. Full time

  3. Part timeFull-time status was defined as 36 h/week, 7.2 h/day and 144 h in a 4-week period. Regular part-time employees were scheduled to less than full time hours but at least 14.4 h/week. Casual employees were scheduled to either full- or part-time hours to cover schedules of nurses who were on leave. Overtime pay was defined as 1.5 times the hourly wage for the number of hours exceeding regular work hours per pay period. Estimation of cost savings if overtime hours were filled by full-time staff.

 Payroll data for registered nurses in acute care hospitals from 2005 to 2008 in a specific health care region in British Columbia, Canada. Each record represented one employee’s 2-week pay period and contained his/her number of regular hours and overtime hours worked, hourly wage rate as well as employment status (full time, part-time, casual), demographic characteristics (age, gender), and department Overtime costs totaled $84 million CDN over the 4-year period and contributed 10%–12% of all costs to workers paid.

  1. Casual: $8,392,433

  2. Full time: $61,065,809

  3. Part time: $14,998,535

    The authors converted overtime pay into full-time equivalents, showed that a net savings of $27.6 million would have been realized if there were enough full-time nurses to alleviate the need for overtime
Guruhagavatula et al. (2008),26 commercial truck drivers; United States of America Peer-reviewed journal Irregular shifts—e.g., shift work and long work hours. Cost analyses of obstructive sleep apnea (OSA) screening. Two methods examined:

  1. In-laboratory polysomnography on all drivers

    or

  2. Selective polysomnography—only drivers who had a high or intermediate risk of OSA, as determined by multivariable model based on age, gender, and body mass indexCompared costs of OSA screening, treatment and residual crashes (i.e., motor vehicle crashes (MVCs) that occur if OSA program misses cases or if identified cases do not accept treatment) against the cost of crashes when screening is not done

 Total cost of screening program: Summed cost of testing, treatment plus crashes.
  1. Testing related expenses obtained from 3500 hospital-based sleep studies:
    • In-lab polysomnography expenses (i.e., technical, administrative and physician services, supplies, equipment, services, and facility rental) from sleep studies.
    • Selective polysomnography expenses included costs attributed to oximetry, polysomnography, and misclassification of OSA

  2. Treatment costs based on:

    Annual cost of continuous positive airway pressure (CPAP) treatment for supplier (i.e., polysomnography, CPAP unit and accessories, labor, and service) multiplied by number of cases identified by program (i.e., in-laboratory polysomnography and selective polysomnography)

  3. MVC (attributable to OSA) costs based on:
    • Federal data for large trucks (National Center for Statistics and Analysis, US Department of Transportation) and odds ratio reported in prior studies for crash associated with OSA syndrome
    • Cost of large truck- and bus-involved crashes (Office of Research and Technology, Federal Motor Carrier Safety Administration)—includes costs of medical treatment, emergency services, property damage, lost productivity, and monetary value of the pain, suffering and reduced quality of life experienced by the victim and his/her family
 Cost of not screening commercial drivers: $689/driver (USD). In-laboratory polysomnography screening not cost effective: $920 (USD)/driver. This is 1/3 more expensive than not screening at all. Selective polysomnography is cost-effective: $358 (1-stage; sleep study to evaluate for OSA) to $372 (2-stage; sleep study to evaluate for OSA + oximetry)/driver. The survey was conducted from 1996 to 1998 so all costs are reported in 1997 dollars, where $1 = $1.64 in 2020
Hafner et al. (2016),27 no specific industry or occupation described; five countries from the Organisation for Economic Co-operation and Development (OECD) countries (i.e., Japan, United States, United Kingdom, Germany, Canada) White paper/report Irregular hours (e.g., shift work). Objectives of the study:

  1. Link between insufficient sleep and (all-cause)-mortality

  2. Association between insufficient sleep and workplace productivity

  3. Economic costs of insufficient sleep examined across three different scenariosScenario 1: Short sleepers (<7 h/day) obtain recommended 7–9 h sleep/day. Scenario 2: Those sleeping <6 h/day obtain 6–7 h/day. Scenario 3: Those sleeping 6–7 h/day started sleeping 7–9 h/day with no change among those sleeping <6h. Costs include loss of future productivity due to increased mortality among short sleepers, reduced productivity due to absenteeism/presenteeism and future losses in productivity due to insufficient sleep on skill development among adolescents.

 Data were gathered from prior studies to estimate the association of short sleep with all-cause mortality, productivity losses at the employer level, and school achievement among adolescents. To determine losses for each OECD country described, additional national-level economic data (e.g., human/physical capital stock, capital/labor ratios, multifactor productivity, and total hours worked) were obtained from Penn World Tables, OECD, and the World Bank. Proportion of working population sleeping less than the recommended sleep duration was gathered from the National Sleep Foundation Survey (2013). Population projections were based on data from the United Nations (2014) and an adapted version of Chapin’s cohort-component model Scenario 1: Short sleepers (<7 h/day) sleep longer and obtain recommended 7–9 h sleep/day. Costs/year for 2015–2030:

  • United States: $411 billion–$467 billion (2.28%–2.59% of GDP)

  • United Kingdom: $50 billion–$58.7 billion (1.86%–2.17% of GDP)

  • Japan: $138 billion–$156.2 billion (2.92% of GDP)

  • Germany: $60 billion-$69.1 billion (1.56%–1.79% of GDP)

  • Canada: $21.4 billion-$23.4 billion (1.35%–1.47% of GDP)

Scenario 2: Those sleeping <6 h/day sleep longer and obtain 6–7 h/day. Costs/year for 2015–2030:

  • United States: $281 billion–$330 billion (1.56%–1.83% of GDP)

  • United Kingdom: $36.7 billion-$44.1 billion (1.36%–1.63% of GDP)

  • Japan: $39.3 billion-$46.6 billion (1.86%–2.14% of GDP)

  • Germany: $39.3 billion-$46.6 billion) (1.02%–1.21% of GDP)

  • Canada: $13.5 billion–$15.1 billion (0.85%–0.95% of GDP)

Scenario 3: Those sleeping 6–7 h/day started sleeping 7–9 h/day with no change among those sleeping <6 h. Costs/year for 2015–2030:

  • United States: $357 billion–$407 billion (1.98%–2.26% of GDP)

  • United Kingdom: $43.2 billion–$50.6 billion (1.60%–1.87% of GDP)

  • Japan: $125.8 billion–$141.7 billion (2.66%–2.99%of GDP)

  • Germany: $54.8 billion–$62.9 billion) (1.42%–1.63% of GDP)

  • Canada: $19.8 billion–$21.6 billion (1.24%–1.36% of GDP)Insufficient sleep among its populations cost the five OECD countries up to $680 billion of economic output lost every year, with costs rising over time
Horwitz and McCall (2004),28 Hospital employees; United States of America Peer-reviewed literature Evening (12–7 p.m.) and night (8 p.m. –3 a.m.) shift work. Compensation for lost-time disability Oregon workers’ compensation claim data from 1990 to 1997, restricted to hospital workers, hospital employment data from Oregon’s Labor Market Information System.
Compensation data included: Claimant occupation and industry, claimant demographics (e.g., age, gender), nature of reported injury, body part affected, compensated days of lost work by claimant, claimant cost, and time claimant started work		 For all hospital employee claims, the average total amount per claim amounted to $6213 (SD = $13,382). An analysis of claim cost differences by shift shows that those working night shift had the highest claim costs, averaging $6715 (SD = $12,856), with day shift workers averaging $6187 (SD = $12,470), and evening shift employee claim costs averaging $6103 (SD = $15,338). Differences in total compensation were not statistically significant.
Regression analyses showed night shift workers claimed significantly more lost-work time than day and evening shifts, while controlling for gender, age, event causing injury, nature of injury, occupation, year of injury and weekly wage of claimant
The authors conclude that lower claim costs (medical, permanent partial disability, and vocational training) among night shift workers offset the lost-work time resulting in nonsignificant differences in total compensation
Iwasaki et al. (2006),29 no specific industry or occupation described; Japan Peer-reviewed Long work hours. Compensation for work or family of worker due to Karoshi—death or permanent disability attributed to cardiovascular disease caused by excessive work hours as defined by the Japanese Ministry of Health, Labor and Welfare as “100 h of overtime in the month before the death, or 80 h of overtime work in two or more consecutive months” Data sources not provided Compensation amount is provided for a single case: 45-year-old male, yearly income of 6.4 million yen (~$55,000 USD), with a wife and two children
Total benefit awarded to survivors was approximately 88 million yen (~ $760,000 USD) composed of a lump-sum payment and a pension under the compensation system
Leger (1994),30 no specific industry or occupation described; United States of America Peer-reviewed journal Work occurring during times of circadian lows (2:00 and 7:00 a.m. and 2:00 and 5:00 p.m.) and overnight hours. Cost of work-related MVCs and accidents. Direct and indirect costs were provided:

  • Direct costs include wage loss, money to repair materials, medical fees, insurance administration, legal fees, and property damage/repair costs

  • Indirect costs represent the loss of production and welfare for the individual and the nation due to premature death or disability. The indirect cost of accidents includes costs of administration and human capital (this represents lost productivity for injuries or a fatality and is adjusted for individuals’ willingness to pay to reduce their risk of death or injury)

 Cost of work-related accidents and MVCs during circadian lows and overnight hours were calculated in two steps: Step 1: Direct and indirect cost of motor vehicle accidents from National Highway Transportation Safety Administration based on the severity of MVC in terms of injury/fatality per-victim or per-vehicle
Cost of work-related MVCs and injuries obtained from National Safety Council. Provided direct and indirect costs for injury (incapacitating, nonincapacitating and possible injury) and fatalities
Wage losses were determined using earnings data from the Bureau of Labor Statistics, adjusted for wage supplements such as social insurance, private pensions and welfare funds. Actual losses are used for nonfatal injuries and present value of all future earnings lost are considered for fatalities and permanent disabilities. Household work is also estimated using the market value of commercial household services
Step 2: Proportion of work-related accidents and MVCs occurring during times of circadian lows and overnight hours were applied to total costs of work-related injuries and MVCs		 52.5% of all work-related injuries and fatalities during 1988 were estimated to be related to sleepiness due to work during circadian lows and overnight hours = $24.7 billion. ($55.57 billion in 2020 dollars)
National Safety Council (2019),23 all workers; United States of America Gray literature Night shifts, rotating shifts, or between midnight and 6 a.m. Costs related to sleep deficiencies (<7 h/night) and sleep disorders (e.g., insomnia, OSA, restless legs syndrome, shift work sleep disorder) are calculated by the NSC cost calculator for individual businesses based on user-provided information such as industry, workforce size, and geographical location
Costs provided by the calculator include absenteeism, reduced productivity and health care expenses
Intervention: Cost-saving estimates based on occupationally based sleep health education and sleep disorder screening programs		 Data about the specific organization is provided by the user into the Fatigue calculator
Cost calculator determines cost of fatigue based on three types of information provided by the user: (workforce size, industry/occupation, workforce geographic location).
Other data sources:
American Time Use survey was used to determine prevalence of nonstandard work schedules for industry categories. Sleep duration was ascertained by state from the Behavioral Risk Factor Surveillance System. Adjustments for sleep problems among night shift workers were made using the National Sleep Foundation information. Costs related to sleep disorders, absenteeism and health disorders were gathered from prior studies. Presenteeism costs were obtained from the American Insomnia Survey and RAND Corporation reports		 Calculator provides estimates specific to user
Total annual cost of fatigue is estimated for absenteeism, decreased productivity and healthcare
The averted costs associated with an employer-initiated sleep health education program was also provided based on user-estimate of number of employees who would be engaged in the program
Sjølie and Bosely (2009),22 no specific industry or occupation described; Denmark Gray literature Night shifts. Compensation paid to women who had worked night shifts for more than 20 years at least one night per week Danish National Board of Industrial Injuries Thirty-eight women, all of whom have worked night shift patterns for more than 20 years, received compensation. Of those, seven who were nurses received between 30,000 and one million Danish kroner (US $4740–158,150) in compensation
Wong et al. (2011),31 no specific industry or occupation described; Canada Peer-reviewed journal Shift work: Regular nights, rotating shifts, other. The annual cost of lost-time claims due to risk of injury associated with shift work Statistics Canada Data: Survey of Labour Income Dynamics. Includes information gathered from federal income tax returns, such as receipt of lost-time of work injury compensation benefits over the past year Estimated cost of lost-time claims due to risk of injury associated with shift work: CA $50.5 million (US$ 43.3 million)