Presentation (CTI)

OBJECTIVES: Incorporating productivity impacts into health economic evaluations supports the adoption of a societal perspective and provides a more comprehensive assessment of health intervention value. However, the extent of inclusion and recommended methodological approaches vary considerably across Health Technology Assessment (HTA) agencies in Europe, particularly regarding the Human Capital Approach (HCA) and the Friction Cost Approach (FCA). This study evaluates if and how productivity is addressed in HTA across the European Economic Area (EEA) and the United Kingdom.
METHODS: A targeted review of publicly available national HTA guidelines was conducted across 31 European countries. The review identified whether the inclusion of productivity is recommended, which valuation approach (HCA or FCA) is preferred, and how such analyses are integrated (reference case or scenario analysis).
RESULTS: HTA guidelines were identified for 24 countries. Two countries (Netherlands and Sweden) consider productivity in the reference case analysis used for decision-making. Two countries (Denmark and Norway) recommend not to include productivity in economic evaluations. One country (Austria) recommends sub-analyses depending on the chosen perspective. The other 16 countries include productivity within a societal perspective, mainly through complementary or scenario analyses, particularly when costs extend significantly beyond the payer healthcare system. Portugal, Slovenia and Slovakia do not specify whether productivity should be included. Three countries (Bulgaria, Spain, Sweden) stated a methodological preference for HCA, while three (Germany, the Netherlands, Poland) prefer FCA. Both methods are accepted in Austria, Belgium and France, depending on justification. Twelve countries do not specify a preferred approach.
CONCLUSIONS: There is wide divergence in how productivity is considered within European HTA guidelines, both in terms of inclusion and valuation method. While productivity is often acknowledged, it is typically included in scenario analysis rather than the reference case limiting its influence on decision-making. Harmonising guidance could improve comparability and comprehensiveness in cross-country assessments.