Table 1.
Recommendations on the inclusion of productivity loss in economic evaluations
| Country/region* | Publication year | Perspective | Inclusion of PL in the base case | Identification of PL | Measurement of PL |
| Africa | |||||
| South Africa45 | 2013 | Payer perspective | No, indirect costs should be excluded. | NA | NA |
| Egypt46 | 2013 | Healthcare perspective | No. But it could be included in separate analysis. | NA | NA |
| Latin America | |||||
| Brazil47 | 2014 | No preferred perspective | It depended on the selection of perspective. | NA | NA |
| Colombia48 | 2014 | Healthcare perspective | No, indirect costs and direct non-medical costs should be excluded. | NA | NA |
| Cuba49 | 2003 | No preferred perspective | It depended on the selection of perspective. | NA | NA |
| Mexico50 | 2015 | Healthcare perspective | No, indirect costs should be excluded. | NA | NA |
| MERCOSUR51 | 2015 | No preferred perspective | It depended on the selection of perspective. | NA | NA |
| North America | |||||
| USA17 | 2020 (ICER) | Healthcare perspective | No. But it could be included in separate analysis. Healthcare sector and modified societal perspectives should be presented together in the base case if indirect costs is substantial, and these costs are considered largely relevant to direct costs. |
Paid work loss; unpaid work loss | NA |
| USA52 | 2016 (second panel) | Both healthcare perspective and societal perspective | Yes, future productivity and consumption should be included. | Paid work loss; unpaid work loss | NA |
| USA53 | 2020 (AMCP) | Healthcare perspective | No specific statement. | NA | NA |
| Canada20 | 2017 | Public payer perspective | No, PL should not be included. | Paid work loss (absenteeism and presenteeism); unpaid work loss; costs of hiring and training new workers for replacement | FCA for base case; other approaches for additional analyses |
| Asia | |||||
| Mainland China6 | 2020 | Both healthcare perspective and societal perspective | Yes, from the societal perspective, indirect costs should be included. | Paid work loss; PL due to premature death | HCA |
| Taiwan (China)54 | 2008 | Societal perspective | Yes. From the societal perspective, indirect costs should be included. | Paid work loss; PL due to premature death | HCA |
| Japan55 | 2019 | Healthcare perspective | No. But PL could be included in a separate analysis, if it can be estimated using Japanese data. | Paid work loss | HCA |
| Malaysia56 | 2019 | Payer perspective | No, PL should be excluded. | NA | NA |
| South Korea57 | 2013 | Limited societal perspective | No, PL should be excluded. | NA | NA |
| Iran58 | NA | Societal perspective | Yes | NA | NA |
| Israel59 | 2010 | Healthcare perspective | No | NA | NA |
| Thailand11 | 2014 | Societal perspective | Yes, indirect costs should be included. | Paid work loss (absenteeism and presenteeism) | HCA |
| Indonesia60 | 2017 | Societal perspective | Yes, indirect costs should be included. | NA | NA |
| Philippines61 | 2020 | Payer perspective | No. Only costs related to the healthcare system should be included. | NA | NA |
| Singapore62 | 2019 | Healthcare perspective | No. But indirect costs are permitted in the additional analyses. | NA | NA |
| Europe | |||||
| Austria63 | 2006 | No preferred perspective | It depended on the selection of perspective. | NA | NA |
| Denmark13 | 2007 | Societal perspective | Yes, production loss/gains should be included. | Paid work loss (absenteeism and presenteeism); PL due to premature death | NA |
| Hungary64 | 2017 | Payer perspective | No, productivity costs must be disregarded. | NA | NA |
| Italy65 | 2020 | Healthcare perspective | No. But indirect costs and non-health care costs could be considered in a supplementary analysis from the societal perspective. | NA | NA |
| Russia66 | 2016 | Healthcare perspective | No | NA | NA |
| Spain67 | 2010 | Societal perspective | Yes. The results of healthcare costs, PL/lost time and care costs should be expressed separately. | NA | NA |
| Croatia68 | 2011 | Payer perspective | No | NA | NA |
| Baltic†69 | 2002 | Healthcare perspective | No. If relevant, include all costs outside healthcare system and present separately. | NA | NA |
| Belgium16 | 2015 | Healthcare perspective | No. But it could be included in separate analysis. | Paid work loss; unpaid work loss | HCA for short-term PL; FCA for long-term PL |
| France70 | 2020 | Healthcare perspective | No. But it could be included in separate analysis. Indirect costs can be identified when health interventions concern life-threatening conditions with total or partial incapacity in carrying out an activity. | NA | NA |
| Germany71 | 2009 | Payer perspective | No. But it could be included in separate analysis, if PL is substantially affected by a new health technology. | NA | HCA for base case; FCA for sensitivity analysis |
| Ireland12 | 2019 | Healthcare perspective | No. But it could be included in separate analysis. | Paid work loss (absenteeism and presenteeism) | NA |
| The Netherlands72 | 2016 | Societal perspective | Yes, if illness or treatment prevents people from being productive, the productivity losses (or gains) involved must be specified and valued. | Paid work loss (absenteeism and presenteeism); unpaid work loss | FCA |
| Norway73 | 2018 | Healthcare perspective | No, PL should be excluded. | NA | NA |
| Portugal74 | 1998 | Societal perspective | Yes, all indirect costs should be identified. | NA | NA |
| Slovak75 | 2011 | Healthcare perspective | No. Only direct health costs should be included. | NA | NA |
| Slovenia76 | 2013 | Payer perspective | No. Only direct health costs should be included. | NA | NA |
| Sweden77 | 2018 | Societal perspective | Yes, all relevant indirect costs should be included. | Paid work loss (absenteeism and presenteeism); PL due to premature death | HCA and FCA |
| Switzerland78 | 2011 | Healthcare perspective | No | NA | NA |
| Czech79 | 2017 | Healthcare perspective | No | NA | NA |
| England and Wales80 | 2013 | Healthcare perspective | No, productivity costs are not included in either the reference case or non-reference case analyses. | NA | NA |
| Scotland81 | 2020 | Healthcare perspective | No | NA | NA |
| Finland82 | 2019 | Payer perspective | No. But if productivity losses are included in the cost inventory, the results should be interpreted. | Paid work loss (absenteeism and presenteeism); PL due to premature death | NA |
| Poland83 | 2016 | Payer perspective | No. Only direct health costs should be included. | NA | FCA for base case; HCA for sensitivity analysis |
| Oceania | |||||
| Australia19 | 2016 | Healthcare perspective | No, costs and outcomes that are not specifically related to ‘health and/or provision of healthcare’ should not be included in the base case. PL could be included in the supplementary analyses. | NA | NA |
| New Zealand18 | 2015 | Healthcare perspective | No, indirect patient costs should be excluded. | NA | NA |
*We included health technology assessment (HTA) guidelines by official HTA agencies and other organisations that conduct HTA within countries (eg, ICER in the USA).
†Baltic includes Latvia, Lithuania and Estonia.
AMCP, Academy of Managed Care Pharmacy; FCA, friction cost approach; HCA, human capital approach; ICER, Institute for Clinical and Economic Review; MERCOSUR, officially refers to Southern Common Market, including Argentina, Brazil, Paraguay, and Uruguay as full members, and Bolivia, Chile, Colombia, Ecuador, Guyana, Peru, and Suriname as associated countries; NA, not available; PL, productivity loss.