title: Do the Washington Panel recommendations hold for Europe: investigating the relation between quality of life versus work-status, absenteeism and presenteeism.
abstract: BACKGROUND
  The question of how to value lost productivity in economic evaluations has been subject of debate in the past twenty years. According to the Washington panel, lost productivity influences health-related quality of life and should thus be considered a health effect instead of a cost to avoid double counting. Current empirical evidence on the inclusion of income loss when valuing health states is not decisive. We examined the relationship between three aspects of lost productivity (work-status, absenteeism and presenteeism) and patient or social valuation of health-related quality of life (HRQoL).
  
  
  METHODS
  Cross-sectional survey data were collected from a total of 830 respondents with a rheumatic disorder from four West-European countries. Health-related quality of life was expressed in either the European societal utility using EQ-5D-3L or the patient valuation using EQ-VAS. The impact of work-status (four categories), absenteeism (absent from paid work during the past three months), and presenteeism (QQ method) on EQ-5D utilities and VAS scores was examined in linear regression analyses taking into account demographic characteristics and disease severity (duration, pain and restriction).
  
  
  RESULTS
  The relationship between work-status, absenteeism or presenteeism and HRQoL was stronger for patient valuation than societal valuation. Compared to work-status and presenteeism the relationship between absenteeism and HRQoL was even less explicit. However, results for all measures of lost productivity are only marginally significant and negligible compared to the influence of disease-related restrictions.
  
  
  CONCLUSIONS
  This survey study in patients with a rheumatic disorder in four European countries, does not fully support the Washington panel's claim that lost productivity is a significantly related with HRQoL, and this is even more apparent for absenteeism than for work-status and presenteeism. For West-European countries, there is no reason, to include absenteeism in the QALY. Findings need to be confirmed in other disease areas.
authors.affiliation: Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, the Netherlands ; National Health Care Institute, PO Box 320, 1110 AH Diemen, the Netherlands ; Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: Knies
authors.affiliation: Department of Internal Medicine, Division of Rheumatology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Center+, Maastricht, the Netherlands.
authors.forename: Annelies
authors.initials: A
authors.lastname: Boonen
authors.affiliation: Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands ; Institute of Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, the Netherlands.
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
keywords: Productivity losses; Quality of life; Relation; Valuation