A Model-Based Estimation of Productivity-Adjusted Life Years Due to Depression in Germany
Author(s)
Lisa Arnold, MSc1, Thomas Reinhold, Prof. Dr.1, Felix Fischer, PD Dr.2, Zanfina Ademi, MPH, PhD3.
1Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany, 2Department of Psychosomatic Medicine, Charité University Medicine Berlin, Berlin, Germany, 3Centre for Medicine Use and Safety, Monash University, Melbourne, Australia.
1Institute of Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin, Germany, 2Department of Psychosomatic Medicine, Charité University Medicine Berlin, Berlin, Germany, 3Centre for Medicine Use and Safety, Monash University, Melbourne, Australia.
OBJECTIVES: Depression is a prevalent mental health disorder with substantial impact on an individual's quality of life and functioning. While its burden is often measured using disability-adjusted life years (DALYs) or direct medical costs, the broader impact on work productivity - through missed workdays and presenteeism - remains underexplored. To address this, this study aimed to quantify productivity losses at work and their economic burden in Germany’s working-age population (15+) over a 10-year time horizon.
METHODS: We developed a Markov model simulating incident cases by sex and age, with new individuals entering the model at each cycle to represent young adults joining the workforce. Productivity loss is assessed using Productivity-Adjusted Life Years (PALYs). The model incorporates mild/moderate and severe depression, a tunnel state for individuals in remission, and allows for recurrent cases. Health states are assigned productivity indices ranging from 0 to 1. PALYs are monetized based on salary estimates. Model inputs are sourced from national statistics and literature; future outcomes are discounted at 3% annually. The model was rerun assuming no depression to estimate the attributable impact of depression. Sensitivity and scenario analyses were conducted to explore the impact of varying key assumptions.
RESULTS: Over the 10-year time horizon, depressive episodes accounted for 4.2% of female and 2.4% of male person-years. In total, 1,043,800 discounted PALYs were lost due to depression among women and 608,073 among men. This corresponds to a total discounted loss of over €60 billion in paid productivity over the 10-year period. These results reflect the base case analysis.
CONCLUSIONS: Depression imposes a substantial productivity burden on Germany’s working-age population, highlighting the need for prevention and timely treatment. The estimation of PALYs can further offer a valuable basis for the evaluation of prevention strategies and can support mental health policy decision-making in Germany.
METHODS: We developed a Markov model simulating incident cases by sex and age, with new individuals entering the model at each cycle to represent young adults joining the workforce. Productivity loss is assessed using Productivity-Adjusted Life Years (PALYs). The model incorporates mild/moderate and severe depression, a tunnel state for individuals in remission, and allows for recurrent cases. Health states are assigned productivity indices ranging from 0 to 1. PALYs are monetized based on salary estimates. Model inputs are sourced from national statistics and literature; future outcomes are discounted at 3% annually. The model was rerun assuming no depression to estimate the attributable impact of depression. Sensitivity and scenario analyses were conducted to explore the impact of varying key assumptions.
RESULTS: Over the 10-year time horizon, depressive episodes accounted for 4.2% of female and 2.4% of male person-years. In total, 1,043,800 discounted PALYs were lost due to depression among women and 608,073 among men. This corresponds to a total discounted loss of over €60 billion in paid productivity over the 10-year period. These results reflect the base case analysis.
CONCLUSIONS: Depression imposes a substantial productivity burden on Germany’s working-age population, highlighting the need for prevention and timely treatment. The estimation of PALYs can further offer a valuable basis for the evaluation of prevention strategies and can support mental health policy decision-making in Germany.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE23
Topic
Economic Evaluation, Epidemiology & Public Health
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies, Work & Home Productivity - Indirect Costs
Disease
Mental Health (including addition)