title: 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.
authors: Department of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000, Rotterdam, The Netherlands. krol@bmg.eur.nl.|Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands. krol@bmg.eur.nl.
authors: Marieke
authors: M
authors: Krol
authors: , St. Willibrordus, Curacao.
authors: Jocé
authors: J
authors: Papenburg
authors: Department of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000, Rotterdam, The Netherlands.|Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
authors: Siok Swan
authors: SS
authors: Tan
authors: Department of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000, Rotterdam, The Netherlands.|Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
authors: Werner
authors: W
authors: Brouwer
authors: Department of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000, Rotterdam, The Netherlands.|Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
authors: Leona
authors: L
authors: Hakkaart
mesh_terms: D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational / Q000191:economics*; D017721:Hospital Costs; D055553:Prescription Drugs / Q000191:economics*
chemical_list: D055553:Prescription Drugs
keywords: Economic evaluation; Indirect costs; Productivity costs; Systematic review