Presentation (CTI)

OBJECTIVES: With a growing emphasis on societal elements in health technology assessment, guidance on their practical implementation becomes crucial. This analysis aims to define and address the "productivity trap" in societal cost measurement. This phenomenon describes how enhanced drug effectiveness can, counterintuitively, result in higher productivity losses when measured by the human capital approach.
METHODS: The study highlights that assigning productivity losses only to living patients can result in longer survival accumulating higher losses, particularly in health states with limited work ability. This concept is illustrated by considering a case study based on an intervention in second line metastatic breast cancer. Two solutions are proposed: 1) calculating productivity losses against a common benchmark (e.g., general population) and 2) calculating productivity gains with or without a common benchmark (e.g., best supportive care).
RESULTS: The case study highlights the core problem by showing a scenario where a 1.3 life-year gain over standard of care treatment is associated with heightened productivity losses, amounting to approximately 20,000 GBP. Introducing benchmarking productivity losses against a common reference shows that effective treatments, by extending life and work capacity, reduce the productivity impact. The benchmark allows to estimate the forgone productivity for patients dying prematurely. Alternatively, calculating productivity gains also accounts for losses from dying patients and aligns with the principle that better treatments lead to improved outcomes. This approach simplifies implementation as there is no need for a common benchmark while preserving incremental effects. Both methods mitigate the counter-intuitive increase in reported productivity losses linked to extended survival.
CONCLUSIONS: To escape the productivity trap in societal cost measurement, where longer survival paradoxically increases losses, it is crucial to use external benchmarks or focus on productivity gains. These methods ensure that societal cost evaluations accurately reflect the true benefits of effective treatments on patient productivity.