A noticeable difference? Productivity costs related to paid and unpaid work in economic evaluations on expensive drugs

Abstract

Productivity costs can strongly impact cost-effectiveness outcomes. This study investigated the impact in the context of expensive hospital drugs. This study aimed to: (1) investigate the effect of productivity costs on cost-effectiveness outcomes, (2) determine whether economic evaluations of expensive drugs commonly include productivity costs related to paid and unpaid work, and (3) explore potential reasons for excluding productivity costs from the economic evaluation. We conducted a systematic literature review to identify economic evaluations of 33 expensive drugs. We analysed whether evaluations included productivity costs and whether inclusion or exclusion was related to the study population's age, health and national health economic guidelines. The impact on cost-effectiveness outcomes was assessed in studies that included productivity costs. Of 249 identified economic evaluations of expensive drugs, 22 (9 %) included productivity costs related to paid work. One study included unpaid productivity. Mostly, productivity cost exclusion could not be explained by the study population's age and health status, but national guidelines appeared influential. Productivity costs proved often highly influential. This study indicates that productivity costs in economic evaluations of expensive hospital drugs are commonly and inconsistently ignored in economic evaluations. This warrants caution in interpreting and comparing the results of these evaluations.

Keywords: Economic evaluation; Indirect costs; Productivity costs; Systematic review.

Fig. 1

Flow diagram of the systematic literature review

Fig. 2

ICERS with and without productivity costs. ICERS from: (a) Lindgren et al. [46] (b) van den Hout et al. [33] (c) Davies et al. [41] (d) Kobelt, Sobocki et al. [48] (e) Kobelt et al. [37] (f) Kobelt et al. [43] (g) Boonen et al. [53] (h) Kobelt, Andlin-Sobocki et al. [43] (i) Kobelt, Eberhardt et al. [49] (j) Kobelt et al. [50] (k) Wong et al. [44] (l) Lidgren et al. [54] (m) Norum et al. [52] (n) Kobelt et al. [51] (o) Manns et al. [45] (p) Maniadakis et al. [36] (q) Walsh et al. [33] (r) Norum & Holtmon [34]