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Setiawan E, Cassidy-Seyoum SA, Thriemer K, Carvalho N, Devine A. A Systematic Review of Methods for Estimating Productivity Losses due to Illness or Caregiving in Low- and Middle-Income Countries. PHARMACOECONOMICS 2024:10.1007/s40273-024-01402-x. [PMID: 38874846 DOI: 10.1007/s40273-024-01402-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Productivity losses are often included in costing studies and economic evaluations to provide a comprehensive understanding of the economic burden of disease. Global guidance on estimating productivity losses is sparse, especially for low-and middle-income countries (LMICs) where informal and unpaid work remains dominant. This study aims to describe current practices for valuing productivity losses in LMICs. METHODS We performed a systematic review of studies published before April 2022 using three databases, including PubMed, Cochrane Library and Web of Science Core Collection. We included any costing or economic evaluation study conducted in a LMIC that provided methodological details on how the monetary value for productivity losses was estimated. Two reviewers independently screened articles for inclusion, extracted data and assessed the quality of the studies. RESULTS A total of 281 articles were included. While most studies did not specify the overall approach used to measure and value productivity losses (58%), the human capital approach was the most frequently used approach to measure productivity losses when this was clearly stated (39%). The most common methods to estimate a monetary value for productivity losses were market wages (51%), self-reported wages (28%) and macroeconomic measures (15%). CONCLUSION Reporting standards for productivity losses in LMIC settings have room for improvement. While market wages were the most frequently used method to estimate the monetary value of productivity losses, this relies on context-specific data availability. Until a consensus is reached on if, when and how to include productivity losses in costing and economic evaluation studies, future studies could include a sensitivity analysis to explore the impact of different methods for estimating the monetary value of productivity losses.
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Affiliation(s)
- Ery Setiawan
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Sarah A Cassidy-Seyoum
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Kamala Thriemer
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia
| | - Natalie Carvalho
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Angela Devine
- Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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Margineanu I, Butnaru T, Lam M, Baiceanu D, Dragomir R, Arbore AS, Mahler B, Munteanu I, Mihaltan F, Akkerman O, Alffenaar JW, Stienstra Y. Tuberculosis impacts multiple aspects in quality of life in a Romanian cohort of drug-susceptible and drug resistant patients: A patient-reported outcome measures study. Trop Med Int Health 2024. [PMID: 38794852 DOI: 10.1111/tmi.13996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND Tuberculosis (TB), and especially its drug resistant forms, is responsible for not only significant mortality, but also considerable morbidity, still under-quantified. This study used four Patient-Reported Outcome Measures (PROMS) to assess the status of persons affected by drug-susceptible and drug-resistant TB during their TB treatment or after treatment completion, in Romania, the highest TB burden country in the EU. METHODS People affected by TB in two different regions in Romania were included during and after treatment, following a cross-sectional design. PROMs used were SF-36, EQ-5D-5L, WPAI and the app-based audiometry screening tool 'uHear.' Descriptive statistics and relevant statistical tests were used to compare groups between themselves and with the general Romanian population. RESULTS Both patients with drug-susceptible and drug-resistant TB experience, with drug-resistant patients experiencing statistically significantly more pain and hearing loss. PROMs show some improvement in the after-treatment group; however, compared with the general Romanian population for which data were available, all groups scored lower on all outcome measures. CONCLUSION PROMs offer the possibility of obtaining a more comprehensive view of patients' status, by involving them directly in the medical process and could guide a rehabilitation strategy.
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Affiliation(s)
- Ioana Margineanu
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centrum Groningen, Groningen, the Netherlands
| | - Teodora Butnaru
- Department of Respiratory Medicine, Marius Nasta Tb Institute, Bucharest, Romania
| | - Marjolein Lam
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dragos Baiceanu
- Department of Respiratory Medicine, Marius Nasta Tb Institute, Bucharest, Romania
| | - Raluca Dragomir
- Department of Respiratory Medicine, Marius Nasta Tb Institute, Bucharest, Romania
| | | | - Beatrice Mahler
- Department of Respiratory Medicine, Marius Nasta Tb Institute, Bucharest, Romania
| | - Ioana Munteanu
- Department of Respiratory Medicine, Marius Nasta Tb Institute, Bucharest, Romania
| | - Florin Mihaltan
- Department of Respiratory Medicine, Marius Nasta Tb Institute, Bucharest, Romania
| | - Onno Akkerman
- Department of Pulmonary diseases and Tuberculosis, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Tuberculosis Center Beatrixoord, University of Groningen, University Medical Center Groningen, Haren, the Netherlands
| | - Jan-Willem Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Centrum Groningen, Groningen, the Netherlands
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Westmead Hospital, Westmead, New South Wales, Australia
- Sydney Institute for Infectious Diseases, University of Sydney, Sydney, New South Wales, Australia
| | - Ymkje Stienstra
- Department of Internal Medicine/Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Mendoza-Jiménez MJ, van Exel J, Brouwer W. On spillovers in economic evaluations: definition, mapping review and research agenda. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-023-01658-8. [PMID: 38261132 DOI: 10.1007/s10198-023-01658-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/05/2023] [Indexed: 01/24/2024]
Abstract
An important issue in economic evaluations is determining whether all relevant impacts are considered, given the perspective chosen for the analysis. Acknowledging that patients are not isolated individuals has important implications in this context. Increasingly, the term "spillovers" is used to label consequences of health interventions on others. However, a clear definition of spillovers is lacking, and as a result, the scope of the concept remains unclear. In this study, we aim to clarify the concept of spillovers by proposing a definition applicable in health economic evaluations. To illustrate the implications of this definition, we highlight the diversity of potential spillovers through an expanded impact inventory and conduct a mapping review that outlines the evidence base for the different types of spillovers. In the context of economic evaluations of health interventions, we define spillovers as all impacts from an intervention on all parties or entities other than the users of the intervention under evaluation. This definition encompasses a broader range of potential costs and effects, beyond informal caregivers and family members. The expanded impact inventory enables a systematic approach to identifying broader impacts of health interventions. The mapping review shows that the relevance of different types of spillovers is context-specific. Some spillovers are regularly included in economic evaluations, although not always recognised as such, while others are not. A consistent use of the term "spillovers", improved measurement of these costs and effects, and increased transparency in reporting them are still necessary. To that end, we propose a research agenda.
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Affiliation(s)
- María J Mendoza-Jiménez
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands.
- Facultad de Ciencias Sociales y Humanísticas, Escuela Superior Politécnica del Litoral (ESPOL), Guayaquil, Ecuador.
| | - Job van Exel
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner Brouwer
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Berger M, Mayer S, Simon J. A novel set of Austrian reference unit costs for comprehensive societal perspectives consistent with latest European costing methods for economic evaluations. Wien Klin Wochenschr 2024; 136:1-12. [PMID: 36564501 PMCID: PMC9786525 DOI: 10.1007/s00508-022-02128-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022]
Abstract
Decision making in public health often happens against the background of scarce resources. The systematic use of economic evaluations can be a main enabler in the alignment of public health goals with budgetary constraints. However, the lack of standardized methodology in terms of costing method and perspective are a critical barrier to the implementation of economic evaluations and the international comparability of results. We present a novel set of 22 reference unit costs (RUCs) optimized for cross-sectoral economic evaluations in Austria suitable for international comparability calculated using the standardized PECUNIA RUC Template. The common framework for costing and reporting, as well as the easy availability of the RUCs will reduce the burden on researchers and policy makers in future economic evaluations. The higher quality, accuracy, transparency and availability of economic evidence for policy design will help to improve the efficiency of public health-relevant healthcare decisions and make it easier for policy makers to bring funding arrangements and decision making across multiple sectors in line with Health-in-All-Policies goals.
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Affiliation(s)
- Michael Berger
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
- Department of Psychiatry, University of Oxford, Warneford Hospital, OX3 7JX, Oxford, UK.
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Pouget AM, Costa N, Mounié M, Gombault-Datzenko E, Derumeaux H, Pagès A, Rouzaud-Laborde C, Molinier L. Mechanical Thrombectomy with Intravenous Thrombolysis versus Thrombolysis Alone for the Treatment of Stroke: A Systematic Review of Economic Evaluations. J Vasc Interv Radiol 2023; 34:1749-1759.e2. [PMID: 37331591 DOI: 10.1016/j.jvir.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/25/2023] [Accepted: 06/08/2023] [Indexed: 06/20/2023] Open
Abstract
Mechanical thrombectomy has revolutionized the management of stroke by improving the recanalization rates and reducing deleterious consequences. It is now the standard of care despite the high financial cost. A considerable number of studies have evaluated its cost effectiveness. Therefore, this study aimed to identify economic evaluations of mechanical thrombectomy with thrombolysis compared with thrombolysis alone to provide an update of existing evidence, focusing on the period after proof of effectiveness of mechanical thrombectomy. Twenty-one studies were included in the review: 18 were model-based economic evaluations to simulate long-term outcomes and costs, and 19 were conducted in high-income countries. Incremental cost-effectiveness ratios ranged from -$5,670 to $74,216 per quality-adjusted life year. Mechanical thrombectomy is cost-effective in high-income countries and in the populations selected for clinical trials. However, most of the studies used the same data. There is a lack of real-world and long-term data to analyze the cost effectiveness of mechanical thrombectomy in treating the global burden of stroke.
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Affiliation(s)
- Alix Marie Pouget
- Health Economic Unit, Toulouse University Hospital, Toulouse, France; Department of Pharmacy, Toulouse University Hospital, Toulouse, France; French National Institute for Health and Medical Research (INSERM), Mixed Research Unit 1297 (UMR), Institute of Metabolic and Cardiac Diseases (I2MC), Toulouse III University, Toulouse, France.
| | - Nadège Costa
- Health Economic Unit, Toulouse University Hospital, Toulouse, France; French National Institute for Health and Medical Research (INSERM), Mixed Research Unit 1297 (UMR), Centre for Epidemiology and Population Health Research (for CERPOP), Toulouse III University, Toulouse, France
| | - Michael Mounié
- Health Economic Unit, Toulouse University Hospital, Toulouse, France; French National Institute for Health and Medical Research (INSERM), Mixed Research Unit 1297 (UMR), Centre for Epidemiology and Population Health Research (for CERPOP), Toulouse III University, Toulouse, France
| | - Eugénie Gombault-Datzenko
- Health Economic Unit, Toulouse University Hospital, Toulouse, France; French National Institute for Health and Medical Research (INSERM), Mixed Research Unit 1297 (UMR), Centre for Epidemiology and Population Health Research (for CERPOP), Toulouse III University, Toulouse, France
| | - Hélène Derumeaux
- Health Economic Unit, Toulouse University Hospital, Toulouse, France; French National Institute for Health and Medical Research (INSERM), Mixed Research Unit 1297 (UMR), Centre for Epidemiology and Population Health Research (for CERPOP), Toulouse III University, Toulouse, France
| | - Arnaud Pagès
- Health Economic Unit, Toulouse University Hospital, Toulouse, France
| | - Charlotte Rouzaud-Laborde
- Department of Pharmacy, Toulouse University Hospital, Toulouse, France; French National Institute for Health and Medical Research (INSERM), Mixed Research Unit 1297 (UMR), Institute of Metabolic and Cardiac Diseases (I2MC), Toulouse III University, Toulouse, France
| | - Laurent Molinier
- Health Economic Unit, Toulouse University Hospital, Toulouse, France; French National Institute for Health and Medical Research (INSERM), Mixed Research Unit 1297 (UMR), Centre for Epidemiology and Population Health Research (for CERPOP), Toulouse III University, Toulouse, France
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Wederfoort JLM, Voeten N, Smeins NNPM, Hommes JE, Essers BAB, van der Hulst RRWJ, Piatkowski A. A Dutch randomized controlled study shows autologous fat transfer with pre-expansion is more cost-effective in the long term than implants. J Plast Reconstr Aesthet Surg 2023; 84:398-412. [PMID: 37399660 DOI: 10.1016/j.bjps.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/31/2023] [Accepted: 06/03/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND One in seven women will develop breast cancer, making it the most common female cancer worldwide. Consequently, breast cancer-related treatment, including breast reconstruction, impacts societal costs. Autologous fat transfer (AFT) is a relatively new breast reconstruction technique; however, several surgeries are necessary. This study investigates if AFT with pre-expansion is more cost-effective than implant-based reconstruction (IBR). METHODS Seven centers assigned patients randomly from 2015 to 2021 to evaluate costs and EQ-5D-5L quality-adjusted life years (QALY) of AFT vs. IBR at 12 months postoperative. Costs were calculated, including direct costs related to treatment and PROductivity and DISease Questionnaire, to estimate productivity loss (indirect costs). Sensitivity analyses were performed for 10- and 30 years to estimate costs for patients replacing or explanting their breast implants over time. RESULTS A total of 152 women, of which 91 received AFT (mean age 49.3) and 80 IBR (mean age 49.1). The mean EQ-5D-5L QALY in the AFT group was 0.83, compared with the IBR group of 0.79. Total costs for AFT at 12 months postoperative were higher than IBR (incremental cost: €6763.59). Sensitivity analyses for 10- and 30-year scenarios showed mean incremental costs of respectively €2586.56 and €680.22. CONCLUSION Mean EQ-5D-5L QALY and costs were higher for AFT over the first year after reconstruction. However, these costs were low; therefore, AFT was estimated to be more cost-effective over the 10- and 30-year period since no additional surgeries are necessary for this group. Larger cohorts are required to confirm AFT is more cost-effective in the long term.
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Affiliation(s)
- J L M Wederfoort
- Department of Plastic-, Reconstructive-, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
| | - N Voeten
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - N N P M Smeins
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - J E Hommes
- Department of Plastic-, Reconstructive-, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - B A B Essers
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, the Netherlands
| | - R R W J van der Hulst
- Department of Plastic-, Reconstructive-, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - A Piatkowski
- Department of Plastic-, Reconstructive-, and Hand Surgery, Maastricht University Medical Center+, Maastricht, the Netherlands; Department of Plastic-, Reconstructive-, and Hand Surgery, Viecuri Medical Center, Venlo, the Netherlands
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7
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Brouwer W, Verbooy K, Hoefman R, van Exel J. Production Losses due to Absenteeism and Presenteeism: The Influence of Compensation Mechanisms and Multiplier Effects. PHARMACOECONOMICS 2023; 41:1103-1115. [PMID: 36856941 PMCID: PMC9976676 DOI: 10.1007/s40273-023-01253-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Productivity costs can form a large and influential component of total costs in an economic evaluation taking a societal perspective. In calculating productivity costs, estimating productivity losses is a central element. Compensation mechanisms and multiplier effects may influence these losses but remain understudied. Compensation mechanisms could reduce productivity losses while multiplier effects may increase them. METHODS Data on productivity losses were collected in 2015 using an online survey among a sample of persons aged 15-65 years in The Netherlands who worked at least 12 h per week and reported to have experienced absenteeism and/or presenteeism during the past 4 weeks. A total of 877 respondents completed the survey that contained questions on productivity losses, compensation mechanisms, and multiplier effects. RESULTS We found that 45.5% of the respondents reported absenteeism (average 6.5 days) during the past 4 weeks, losing on average 48.7 working hours, while presenteeism was experienced by 75.9% of respondents, with an average loss of 10.7 working hours. Compensation mechanisms were reported by 76.9% of respondents, compensating almost 80% of their lost production, while multiplier effects were reported by 23.6% of respondents, reducing the productivity of 4.2 colleagues by 27.8% on average, implying a multiplier of 2.1 in that subgroup. CONCLUSIONS This study highlights that compensation mechanisms and multiplier effects are common and may substantially affect production losses. Investigating these mechanisms and effects further, as well as their interactions, remains important. Translating these findings into productivity cost calculations in economic evaluations is not straightforward and requires attention, especially since compensation mechanisms may not be costless and, for multiplier effects, the value of hours of colleagues may not be similar to that of the person experiencing health problems.
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Affiliation(s)
- Werner Brouwer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
- Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Kaya Verbooy
- Hotel Management School Maastricht, Maastricht, The Netherlands
| | - Renske Hoefman
- The Netherlands Institute for Social Research, The Hague, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, PO Box 1738, 3000 DR, Rotterdam, The Netherlands
- Erasmus Centre for Health Economics Rotterdam, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Krol M, Hosseinnia N, Brouwer W, van Roijen LH. Multiplier Effects and Compensation Mechanisms for Inclusion in Health Economic Evaluation: A Systematic Review. PHARMACOECONOMICS 2023; 41:1031-1050. [PMID: 37592122 PMCID: PMC10450000 DOI: 10.1007/s40273-023-01304-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Compensation mechanisms and multiplier effects may affect productivity losses due to illness, disability, or premature death of individuals. Hence, they are important in estimating productivity losses and productivity costs in the context of economic evaluations of health interventions. This paper presents a systematic literature review of papers focusing on compensation mechanisms and multiplier effects, as well as whether and how they are included in health economic evaluations. METHODS The systematic literature search was performed covering EconLit and PubMed. A data-extraction form was developed focusing on compensation mechanisms and multiplier effects. RESULTS A total of 26 studies were included. Of these, 15 were empirical studies, three studies were methodological studies, two studies combined methodological research with empirical research, four were critical reviews, one study was a critical review combined with methodological research, and one study was a cost-benefit analysis. No uniform definition of compensation mechanisms and multiplier effects was identified. The terminology used to describe compensation mechanisms and multiplier effects varied as well. While the included studies suggest that both multipliers as well as compensation mechanisms substantially impact productivity cost estimates, the available evidence is scarce. Moreover, the generalizability as well as validity of assumptions underlying the calculations are unclear. Available measurement methods for compensation mechanisms and multiplier effects differ in approaches and are hardly validated. CONCLUSION While our review suggests that compensation mechanisms and multiplier effects may have a significant impact on productivity losses and costs, much remains unclear about their features, valid measurement, and correct valuation. This hampers their current inclusion in economic evaluation, and therefore, more research into both phenomena remains warranted.
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Affiliation(s)
- Marieke Krol
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- IQVIA, Amsterdam, Netherlands
| | - Nikkie Hosseinnia
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Department of Pharmaceutical Science, Utrecht University, Utrecht, Netherlands
| | - Werner Brouwer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Center for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Leona Hakkaart van Roijen
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
- Erasmus Center for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, Netherlands.
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Keita Fakeye MB, Samuel LJ, Drabo EF, Bandeen-Roche K, Wolff JL. Caregiving-Related Work Productivity Loss Among Employed Family and Other Unpaid Caregivers of Older Adults. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:712-720. [PMID: 35973924 PMCID: PMC9922792 DOI: 10.1016/j.jval.2022.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 06/01/2022] [Accepted: 06/16/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Although nearly half of all family and unpaid caregivers to older adults work, little is known about short-term work impacts of caregiving using measures encompassing both missed work time and reduced productivity while physically at work. We quantify the prevalence, costs, and correlates of caregiving-related work productivity loss. METHODS We used the 2015 National Study of Caregiving and National Health and Aging Trends Study to estimate caregiving-related work absences (absenteeism) and reduced productivity while at work (presenteeism). We calculated costs of lost productivity using hours lost, compensation, and a wage multiplier, accounting for the additional cost of replacing employee time. We examined correlates of caregiving-related absenteeism and presenteeism separately, using multivariable logistic regression models, adjusting for caregiver sociodemographic characteristics, occupation and hours worked, role overload, older adult health, use of respite care, support groups, flexible workplace schedules, help from family or friends, and caregiver training. RESULTS Nearly 1 in 4 (23.3%) of the estimated 8.8 million employed family caregivers reported either absenteeism or presenteeism over a 1-month period owing to caregiving. Among those affected, caregiving reduced work productivity by one-third on average-or an estimated $5600 per employee when annualized across all employed caregivers-primarily because of reduced performance while present at work. Productivity loss was higher among caregivers of older adults with significant care needs and varied according to sociodemographic characteristics and caregiver supports. CONCLUSIONS Findings emphasize the potential economic value of targeted policy intervention to support working caregivers.
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Affiliation(s)
- Maningbè B Keita Fakeye
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | - Emmanuel F Drabo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer L Wolff
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Mahdi S, Buckland NJ, Chilcott J. Economic and health impacts of the Change4Life Food Scanner app: Findings from a randomized pilot and feasibility study. Front Nutr 2023; 10:1125542. [PMID: 37006945 PMCID: PMC10061026 DOI: 10.3389/fnut.2023.1125542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
IntroductionThe UK Government developed the Change4Life Food Scanner app to provide families with engaging feedback on the nutritional content of packaged foods. There is a lack of research exploring the cost-effectiveness of dietary health promotion apps.MethodsThrough stakeholder engagement, a conceptual model was developed, outlining the pathway by which the Food Scanner app leads to proximal and distal outcomes. The conceptual model informed the development of a pilot randomized controlled trial which investigated the feasibility and acceptability of evaluating clinical outcomes in children and economic effectiveness of the Food Scanner app through a cost-consequence analysis. Parents of 4–11 years-olds (n = 126) were randomized into an app exposure condition (n = 62), or no intervention control (n = 64). Parent-reported Child Health Utility 9 Dimension (CHU9D) outcomes were collected alongside child healthcare resource use and associated costs, school absenteeism and parent productivity losses at baseline and 3 months follow up. Results for the CHU9D were converted into utility scores based on UK adult preference weights. Sensitivity analysis accounted for outliers and multiple imputation methods were adopted for the handling of missing data.Results64 participants (51%) completed the study (intervention: n = 29; control: n = 35). There was a mean reduction in quality adjusted life years between groups over the trial period of –0.004 (SD = 0.024, 95% CI: –0.005; 0.012). There was a mean reduction in healthcare costs of –£30.77 (SD = 230.97; 95% CI: –£113.80; £52.26) and a mean reduction in workplace productivity losses of –£64.24 (SD = 241.66, 95% CI: –£147.54; £19.07) within the intervention arm, compared to the control arm, over the data collection period. Similar findings were apparent after multiple imputation.DiscussionModest mean differences between study arms may have been due to the exploration of distal outcomes over a short follow-up period. The study was also disrupted due to the coronavirus pandemic, which may have confounded healthcare resource data. Although measures adopted were deemed feasible, the study highlighted difficulties in obtaining data on app development and maintenance costs, as well as the importance of economic modeling to predict long-term outcomes that may not be reliably captured over the short-term.Clinical trial registrationhttps://osf.io/, identifier 62hzt.
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Affiliation(s)
- Sundus Mahdi
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- *Correspondence: Sundus Mahdi,
| | - Nicola J. Buckland
- Department of Psychology, University of Sheffield, Sheffield, United Kingdom
| | - Jim Chilcott
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
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de Oliveira C, Saka M, Bone L, Jacobs R. The Role of Mental Health on Workplace Productivity: A Critical Review of the Literature. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:167-193. [PMID: 36376610 PMCID: PMC9663290 DOI: 10.1007/s40258-022-00761-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Mental health disorders in the workplace have increasingly been recognised as a problem in most countries given their high economic burden. However, few reviews have examined the relationship between mental health and worker productivity. OBJECTIVE To review the relationship between mental health and lost productivity and undertake a critical review of the published literature. METHODS A critical review was undertaken to identify relevant studies published in MEDLINE and EconLit from 1 January 2008 to 31 May 2020, and to examine the type of data and methods employed, study findings and limitations, and existing gaps in the literature. Studies were critically appraised, namely whether they recognised and/or addressed endogeneity and unobserved heterogeneity, and a narrative synthesis of the existing evidence was undertaken. RESULTS Thirty-eight (38) relevant studies were found. There was clear evidence that poor mental health (mostly measured as depression and/or anxiety) was associated with lost productivity (i.e., absenteeism and presenteeism). However, only the most common mental disorders were typically examined. Studies employed questionnaires/surveys and administrative data and regression analysis. Few studies used longitudinal data, controlled for unobserved heterogeneity or addressed endogeneity; therefore, few studies were considered high quality. CONCLUSION Despite consistent findings, more high-quality, longitudinal and causal inference studies are needed to provide clear policy recommendations. Moreover, future research should seek to understand how working conditions and work arrangements as well as workplace policies impact presenteeism.
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Affiliation(s)
- Claire de Oliveira
- Centre for Health Economics, University of York, York, UK.
- Hull York Medical School, Hull and York, UK.
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | | | | | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
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12
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Pokhilenko I, Janssen LMM, Paulus ATG, Drost RMWA, Hollingworth W, Thorn JC, Noble S, Simon J, Fischer C, Mayer S, Salvador-Carulla L, Konnopka A, Hakkaart van Roijen L, Brodszky V, Park AL, Evers SMAA. Development of an Instrument for the Assessment of Health-Related Multi-sectoral Resource Use in Europe: The PECUNIA RUM. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:155-166. [PMID: 36622541 PMCID: PMC9931843 DOI: 10.1007/s40258-022-00780-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Measuring objective resource-use quantities is important for generating valid cost estimates in economic evaluations. In the absence of acknowledged guidelines, measurement methods are often chosen based on practicality rather than methodological evidence. Furthermore, few resource-use measurement (RUM) instruments focus on the measurement of resource use in multiple societal sectors and their development process is rarely described. Thorn and colleagues proposed a stepwise approach to the development of RUM instruments, which has been used for developing cost questionnaires for specific trials. However, it remains unclear how this approach can be translated into practice and whether it is applicable to the development of generic self-reported RUM instruments and instruments measuring resource use in multiple sectors. This study provides a detailed description of the practical application of this stepwise approach to the development of a multi-sectoral RUM instrument developed within the ProgrammE in Costing, resource use measurement and outcome valuation for Use in multi-sectoral National and International health economic evaluAtions (PECUNIA) project. METHODS For the development of the PECUNIA RUM, the methodological approach was based on best practice guidelines. The process included six steps, including the definition of the instrument attributes, identification of cost-driving elements in each sector, review of methodological literature and development of a harmonized cross-sectorial approach, development of questionnaire modules and their subsequent harmonization. RESULTS The selected development approach was, overall, applicable to the development of the PECUNIA RUM. However, due to the complexity of the development of a multi-sectoral RUM instrument, additional steps such as establishing a uniform methodological basis, harmonization of questionnaire modules and involvement of a broader range of stakeholders (healthcare professionals, sector-specific experts, health economists) were needed. CONCLUSION This is the first study that transparently describes the development process of a generic multi-sectoral RUM instrument in health economics and provides insights into the methodological aspects and overall validity of its development process.
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Affiliation(s)
- Irina Pokhilenko
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands.
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Luca M M Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Aggie T G Paulus
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - Ruben M W A Drost
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
| | - William Hollingworth
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna C Thorn
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Noble
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Claudia Fischer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Luis Salvador-Carulla
- Mental Health Policy Unit, Faculty of Health, Health Research Institute, University of Canberra, Canberra, ACT, Australia
- School of Public Health, Menzies Centre for Health Policy, University of Sydney, Sydney, NSW, Australia
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg, Hamburg, Germany
| | - Leona Hakkaart van Roijen
- Erasmus School of Health Policy and Management, Erasmus University of Rotterdam, Rotterdam, The Netherlands
| | - Valentin Brodszky
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary
| | - A-La Park
- Department of Health Policy, Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Silvia M A A Evers
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, The Netherlands
- Trimbos Institute National Institute of Mental Health and Addiction, Utrecht, The Netherlands
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13
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Hafner M, Yerushalmi E, Andersson FL, Burtea T. Partially different? The importance of general equilibrium in health economic evaluations: An application to nocturia. HEALTH ECONOMICS 2023; 32:654-674. [PMID: 36424887 PMCID: PMC10100343 DOI: 10.1002/hec.4638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 09/29/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Both the human capital approach and the friction cost approach are frequently used to quantify the productivity costs associated with illness, disability or death in health economic evaluations. In this paper we argue that these approaches have one major, but common shortcoming: they only capture partial equilibrium (PE) effects and therefore underestimate the true potential productivity costs associated with health conditions. They neglect the sizable, indirect, ripple effects in the economy captured by general equilibrium (GE) models. To demonstrate our point, we compare a traditional PE with a GE approach for the application to nocturia, a condition characterized by the need to frequently wake up at night to urinate. Nocturia is associated with substantial impairment of daytime functioning and work productivity. We employ large-scale United Kingdom (UK) employer-employee survey data to estimate the prevalence and productivity loss. These estimates are then used as shared inputs to drive both approaches. We find that the traditional PE approach underestimates the annual productivity cost of clinically relevant nocturia by around 16%. We propose a generalized GE/PE multiplier to approximate the GE effect for other health conditions. Our findings stress the importance of accounting for sizable GE effects when conducting health economic evaluations.
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Affiliation(s)
| | - Erez Yerushalmi
- Birmingham City Business SchoolBirmingham City UniversityBirminghamUK
| | | | - Teodor Burtea
- Ferring International Center SASaint‐PrexSwitzerland
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14
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Leech AA, Lin PJ, D'Cruz B, Parsons SK, Lavelle TA. Family Spillover Effects: Are Economic Evaluations Misrepresenting the Value of Healthcare Interventions to Society? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:5-10. [PMID: 35997896 PMCID: PMC9839569 DOI: 10.1007/s40258-022-00755-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/03/2022] [Indexed: 06/15/2023]
Abstract
The societal impacts of health interventions are seldom incorporated into health economic evaluations, including the impact that illness can have on informal or unpaid caregivers and other family members (i.e., "family spillover effects"). Previous research has demonstrated that by excluding family spillover effects, the value of health interventions may be underestimated on average. In this commentary, we discuss how the inclusion of spillover effects influences how we value interventions and, given the extent to which caregiver/family effects are largely not captured or known, propose ways in which these data could be more systematically collected or estimated and used by researchers. These recommendations include prioritizing data collection alongside clinical trials and patient registries, engaging expert opinion panels, and developing mapping algorithms for estimating caregiver/family utility values from non-preference-based caregiver health-related quality-of-life measures and/or from patient preference-based measures.
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Affiliation(s)
- Ashley A Leech
- Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 1275-F, Nashville, TN, 37203, USA.
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA.
| | - Pei-Jung Lin
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Brittany D'Cruz
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Susan K Parsons
- Center for Health Solutions, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
- Division of Hematology/Oncology, Tufts Medical Center, Boston, MA, USA
| | - Tara A Lavelle
- Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
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15
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Psychometric Properties of the Traditional Chinese Version of the Stanford Presenteeism Scale (SPS-6) among Taiwanese Employees in Technology Companies. Healthcare (Basel) 2022; 10:healthcare10112202. [PMID: 36360542 PMCID: PMC9690533 DOI: 10.3390/healthcare10112202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Little attention has been paid by employers to reduced productivity at work due to illness (presenteeism) because valid instruments to measure presenteeism are lacking. We assessed psychometric properties of the traditional Chinese version of the six-item Stanford Presenteeism Scale (CSPS-6) among Taiwanese employees in technology companies. We carried out a cross-cultural adaptation study on 196 employees. Factor analyses were used to evaluate the construct validity of the CSPS-6. Cronbach’s alpha was 0.74. The content validity of the CSPS-6 was good. Results of factor analyses confirmed the two-factor model of the CSPS-6. CSPS-6 scores were correlated with job stress (rs = −0.22, p = 0.002), the health status SF-36 (rs = 0.28 to 0.52, p < 0.0001), job satisfaction (rs = 0.41, p < 0.0001), and the presenteeism score of the Work Productivity and Activity Impairment Questionnaire: General Health (rs = −0.46, p < 0.0001). No correlations were found between presenteeism and the disability status (p = 0.19, F-value = 1.67, degrees of freedom = 2). The CSPS-6 was found to be reliable and valid in evaluating presenteeism of Taiwanese employees. Further studies should be undertaken to validate the CSPS-6 in other working populations and assess long-term effects of health problems associated with presenteeism.
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Moe-Byrne T, Shepherd J, Merecz-Kot D, Sinokki M, Naumanen P, Hakkaart-van Roijen L, Van Der Feltz-Cornelis C. Effectiveness of tailored digital health interventions for mental health at the workplace: A systematic review of randomised controlled trials. PLOS DIGITAL HEALTH 2022; 1:e0000123. [PMID: 36812547 PMCID: PMC9931277 DOI: 10.1371/journal.pdig.0000123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 09/09/2022] [Indexed: 06/08/2023]
Abstract
Mental health problems in the workplace are common and have a considerable impact on employee wellbeing and productivity. Mental ill-health costs employers between £33 billion and £42 billion a year. According to a 2020 HSE report, roughly 2,440 per 100,000 workers in the UK were affected by work-related stress, depression, or anxiety, resulting in an estimated 17.9 million working days lost. We performed a systematic review of randomised controlled trials (RCTs) to assess the effect of tailored digital health interventions provided in the workplace aiming to improve mental health, presenteeism and absenteeism of employees. We searched several databases for RCTs published from 2000 onwards. Data were extracted into a standardised data extraction form. The quality of the included studies was assessed using the Cochrane Risk of Bias tool. Due to the heterogeneity of outcome measures, narrative synthesis was used to summarise the findings. Seven RCTs (eight publications) were included that evaluated tailored digital interventions versus waiting list control or usual care to improve physical and mental health outcomes and work productivity. The results are promising to the advantage of tailored digital interventions regarding presenteeism, sleep, stress levels, and physical symptoms related to somatisation; but less for addressing depression, anxiety, and absenteeism. Even though tailored digital interventions did not reduce anxiety and depression in the general working population, they significantly reduced depression and anxiety in employees with higher levels of psychological distress. Tailored digital interventions seem more effective in employees with higher levels of distress, presenteeism or absenteeism than in the general working population. There was high heterogeneity in outcome measures, especially for work productivity; this should be a focus of attention in future studies.
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Affiliation(s)
| | - Jessie Shepherd
- Department of Health Sciences, University of York, York, United Kingdom
| | | | - Marjo Sinokki
- Turku Centre for Occupational Health, University of Turku, Turku, Finland
| | - Päivi Naumanen
- Turku Centre for Occupational Health, University of Turku, Turku, Finland
| | - Leona Hakkaart-van Roijen
- Erasmus School of Health Policy and Management (ESHPM), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Christina Van Der Feltz-Cornelis
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, York, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
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17
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Costa S, Guerreiro J, Teixeira I, Helling DK, Pereira J, Mateus C. Cost-effectiveness and cost-utility of hypertension and hyperlipidemia collaborative management between pharmacies and primary care in portugal alongside a trial compared with usual care (USFarmácia®). Front Pharmacol 2022; 13:903270. [PMID: 36160402 PMCID: PMC9493118 DOI: 10.3389/fphar.2022.903270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/22/2022] [Indexed: 11/22/2022] Open
Abstract
Background: There is little experience in the economic evaluation of pharmacy/primary care collaborative health interventions using interprofessional technology-driven communication under real-world conditions. This study aimed to conduct cost-effectiveness and cost-utility analyses of a collaborative care intervention in hypertension and hyperlipidemia management between pharmacies and primary care versus usual (fragmented) care alongside a trial. Methods: An economic evaluation was conducted alongside a 6-month pragmatic quasi-experimental controlled trial. Data sources included primary care clinical software; pharmacy dispensing software; patient telephone surveys; and published literature. The target population was adult patients on hypertension and/or lipid-lowering medication. The perspective was societal. We collected patient-level data on resource use to estimate trial costs. Effect outcomes included blood pressure (BP) and quality-adjusted life years (QALYs). Bootstrapping was used to estimate uncertainty around the incremental cost-effectiveness and cost-utility ratios. Cost-effectiveness planes and acceptability curves were estimated. Results: The intervention was not shown to have reasonable levels of cost-effectiveness or cost-utility when compared to usual care as denoted by the levels of uncertainty expressed in wide confidence intervals. The probability of the intervention being cost-effective is 28% at the threshold of €20,000 per QALY gained and 57% at the threshold of €500 per mmHg systolic BP decrease. Conclusion: Considering the limitations of the trial which affected effectiveness and economic outcomes, our results are not generalizable for community pharmacy and primary care in Portugal. This research offers, however, valuable lessons on methods and strategies that can be used in future economic evaluations of collaborative public health interventions with the potential for reimbursement. Clinical trial registration:https://www.isrctn.com/ISRCTN13410498, identifier ISRCTN13410498
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Affiliation(s)
- Suzete Costa
- Escola Nacional de Saúde Pública (ENSP), Universidade NOVA de Lisboa, Lisboa, Portugal
- Institute for Evidence-Based Health (ISBE), Lisboa, Portugal
- *Correspondence: Suzete Costa, , orcid.org/0000-0002-4521-5473
| | - José Guerreiro
- Centre for Health Evaluation and Research (CEFAR), Infosaúde, Associação Nacional das Farmácias (ANF), Lisboa, Portugal
| | - Inês Teixeira
- Centre for Health Evaluation and Research (CEFAR), Infosaúde, Associação Nacional das Farmácias (ANF), Lisboa, Portugal
| | - Dennis K. Helling
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, Colorado, United States
| | - João Pereira
- Escola Nacional de Saúde Pública (ENSP), Universidade NOVA de Lisboa, Lisboa, Portugal
- Centro de Investigação em Saúde Pública (CISP), and Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
| | - Céu Mateus
- Health Economics at Lancaster, Division of Health Research, Lancaster University, Lancaster, United Kingdom
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18
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Jiang S, Wang Y, Si L, Zang X, Gu YY, Jiang Y, Liu GG, Wu J. Incorporating productivity loss in health economic evaluations: a review of guidelines and practices worldwide for research agenda in China. BMJ Glob Health 2022; 7:bmjgh-2022-009777. [PMID: 35977755 PMCID: PMC9389102 DOI: 10.1136/bmjgh-2022-009777] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Productivity loss may contribute to a large proportion of costs of health conditions in an economic evaluation from a societal perspective, but there is currently a lack of methodological consensus on how productivity loss should be measured and valued. Despite the research progress surrounding this issue in other countries, it has been rarely discussed in China. Methods We reviewed the official guidelines on economic evaluations in different countries and regions and screened the literature to summarise the extent to which productivity loss was incorporated in economic evaluations and the underlying methodological challenges. Results A total of 48 guidelines from 46 countries/regions were included. Although 32 (67%) guidelines recommend excluding productivity loss in the base case analysis, 23 (48%) guidelines recommend including productivity loss in the base case or additional analyses. Through a review of systematic reviews and the economic evaluation studies included in these reviews, we found that the average probability of incorporating productivity loss in an economic evaluation was 10.2%. Among the economic evaluations (n=478) that explicitly considered productivity loss, most (n=455) considered losses from paid work, while only a few studies (n=23) considered unpaid work losses. Recognising the existing methodological challenges and the specific context of China, we proposed a practical research agenda and a disease list for progress on this topic, including the development of the disease list comprehensively consisting of health conditions where the productivity loss should be incorporated into economic evaluations. Conclusion An increasing number of guidelines recommend the inclusion of productivity loss in the base case or additional analyses of economic evaluation. We optimistically expect that more Chinese researchers notice the importance of incorporating productivity loss in economic evaluations and anticipate guidelines that may be suitable for Chinese practitioners and decision-makers that facilitate the advancement of research on productivity loss measurement and valuation.
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Affiliation(s)
- Shan Jiang
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Yitong Wang
- Public Health Department, Aix- Marseille-University, Marseille, France
| | - Lei Si
- The George Institute for Global Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Xiao Zang
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Yuan-Yuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School and Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-Sen University, Guangzhou, China
| | - Gordon G Liu
- National School of Development, Peking University, Beijing, China.,Institute for Global Health and Development, Peking University, Beijing, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
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Ta-Thi KN, Chuang KJ. A Comparison of the Validities of Traditional Chinese Versions of the Work Productivity and Activity Impairment Questionnaire: General Health and the World Health Organization's Health and Work Performance Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074417. [PMID: 35410101 PMCID: PMC8998541 DOI: 10.3390/ijerph19074417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022]
Abstract
There is a lack of valid instruments for measuring productivity loss due to illness. This study aimed to compare the validities of traditional Chinese versions of the Work Productivity and Activity Impairment: General Health (C-WPAI:GH) and the World Health Organization's Health and Work Performance Questionnaire (C-WHO-HPQ), and to define the factors associated with productivity loss. We conducted a cross-sectional study of 165 Taiwanese employees in technology companies. Spearman's correlation coefficients and ANOVAs were used to test the validities of the C-WPAI:GH and C-WHO-HPQ. Bayesian model averaging was used for multiple linear regression to define the factors related to productivity loss. The C-WPAI:GH had acceptable validities for assessing the productivity loss of Taiwanese employees. The C-WHO-HPQ had acceptable content validity and concurrent criterion validity. However, the construct validity of the C-WHO-HPQ was insufficient (less than 75% of results were consistent with our hypotheses). Absenteeism in the C-WPAI:GH was associated with education, physical functioning and job satisfaction. There were significant associations of bodily pain, social functioning and general health with presenteeism, overall work impairment and activity impairment in the C-WPAI:GH. A linear correlation was found between education and activity impairment in the C-WPAI:GH. The C-WPAI:GH can be used to evaluate productivity loss due to illness.
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Affiliation(s)
- Kim-Ngan Ta-Thi
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 110, Taiwan;
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
| | - Kai-Jen Chuang
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 110, Taiwan;
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
- Correspondence: ; Tel.: +886-2-27361661
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Lamoureux-Lamarche C, Berbiche D, Vasiliadis HM. Health care system and patient costs associated with receipt of minimally adequate treatment for depression and anxiety disorders in older adults. BMC Psychiatry 2022; 22:175. [PMID: 35272650 PMCID: PMC8908583 DOI: 10.1186/s12888-022-03759-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression and anxiety disorders in older adults are associated with a great burden. Research has shown that less than 50% of adults receive adequate treatment in primary care settings for these disorders. Rare are the studies however assessing adequate treatment in older adults and associated costs from the societal perspective. Given the episodic nature of common mental disorders, this study aims to assess the three-year costs from a restricted societal perspective (including health system and patient perspectives) associated with receipt of minimally adequate treatment for depression and anxiety disorders in older adults consulting in primary care. METHODS This primary care cohort study included 358 older adults aged 65 years and older with either a self-reported or physician diagnosis of depression or an anxiety disorder covered under Quebec's public drug plan. Receipt of minimally adequate treatment was assessed according to Canadian guidelines and relevant reports. Outpatient and inpatient service use, medication costs and physician billing fees were obtained from provincial administrative databases. Unit costs were calculated using provincial financial and activity reports and relevant literature. A propensity score was created to estimate the probability of receiving minimally adequate treatment and the inverse probability was used as a weight in analyses. Generalized linear models, with gamma distribution and log link, were conducted to assess the association between receipt of minimally adequate treatment and costs. RESULTS Overall, receipt of minimally adequate treatment was associated with increased three-year costs averaging $5752, $536, $6266 for the health system, patient and societal perspectives, respectively, compared to those not receiving minimally adequate treatment. From the health system perspective, participants receiving minimally adequate treatment had higher costs related to emergency department (ED) (difference: $457, p = 0.001) and outpatient visits (difference: $620, p < 0.001), inpatient stays (difference: $2564, p = 0.025), drug prescriptions (difference: $1243, p = 0.002) and physician fees (difference: $1224, p < 0.001). From the patient perspective, receipt of minimally adequate treatment was associated with higher costs related to loss of productivity related to ED (difference: $213, p < 0.001) and outpatient visits (difference: $89, p < 0.001). CONCLUSIONS Older adults receiving minimally adequate treatment for depression and anxiety disorders incurred higher societal costs reaching $2089 annually compared to older adults not receiving minimally adequate treatment. The main cost drivers were attributable to hospitalizations and prescription drug costs.
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Affiliation(s)
- Catherine Lamoureux-Lamarche
- grid.86715.3d0000 0000 9064 6198Faculty of Medicine and Health Sciences, Campus de Longueuil – Université de Sherbrooke; Centre de recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Quebec J4K 0A8 Longueuil, Canada
| | - Djamal Berbiche
- grid.86715.3d0000 0000 9064 6198Faculty of Medicine and Health Sciences, Campus de Longueuil – Université de Sherbrooke; Centre de recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Quebec J4K 0A8 Longueuil, Canada
| | - Helen-Maria Vasiliadis
- Faculty of Medicine and Health Sciences, Campus de Longueuil - Université de Sherbrooke; Centre de recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Quebec, J4K 0A8, Longueuil, Canada.
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21
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Lambert-Obry V, Lafrance JP, Savoie M, Lachaine J. The Impact of Hypoglycemia on Productivity Loss and Utility in Type 2 Diabetes Patients Treated with Insulin in Real-World Canadian Practice: Protocol for a Prospective Study (Preprint). JMIR Res Protoc 2021; 11:e35461. [PMID: 35343912 PMCID: PMC9002599 DOI: 10.2196/35461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) imposes a substantial burden owing to its increasing prevalence and life-threatening complications. In patients who do not achieve glycemic targets with oral antidiabetic drugs, the initiation of insulin is recommended. However, a serious concern regarding insulin is drug-induced hypoglycemia. Hypoglycemia is known to affect quality of life and the use of health care resources. However, health economics and outcomes research (HEOR) data for economic modelling are limited, particularly regarding utility values and productivity losses. Objective This real-world prospective study aims to assess the impact of hypoglycemia on productivity and utility in insulin-treated adults with T2DM from Ontario and Quebec, Canada. Methods This noninterventional, multicenter, 3-month prospective study will recruit patients from 4 medical clinics and 2 endocrinology or diabetes clinics. Patients will be identified using appointment lists and enrolled through consecutive sampling during routinely scheduled consultations. To be eligible, patients must be aged ≥18 years, diagnosed with T2DM, and treated with insulin. Utility and productivity will be measured using the EQ-5D-5L questionnaire and Institute for Medical Technology Assessment Productivity Cost Questionnaire, respectively. Questionnaires will be completed 4, 8, and 12 weeks after recruitment. Generalized estimating equation models will be used to investigate productivity losses and utility decrements associated with incident hypoglycemic events while controlling for individual patient characteristics. A total of 500 patients will be enrolled to ensure the precision of HEOR estimates. Results This study is designed to fill a gap in the Canadian evidence on the impact of hypoglycemia on HEOR outcomes. More specifically, it will generate productivity and utility inputs for the economic modeling of T2DM. Conclusions Insulin therapy is expensive, and hypoglycemia is a significant component of economic evaluation. Robust HEOR data may help health technology assessment agencies in future reimbursement decision-making. International Registered Report Identifier (IRRID) PRR1-10.2196/35461
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Affiliation(s)
| | | | - Michelle Savoie
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Jean Lachaine
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
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