Presentation (CTI)

OBJECTIVES: Indirect productivity costs are a key component in societal-perspective cost-effectiveness analyses for obesity interventions. As new obesity treatments are evaluated for reimbursement across Europe, reliable indirect cost estimates have become essential. However, available evidence on obesity-related productivity losses originates predominantly from the United States, where institutional structures differ fundamentally from European systems. This review identifies the available European evidence and assesses whether reported effect sizes are usable as input parameters for health economic evaluations.
METHODS: A targeted literature search was conducted in PubMed (2000-2026). Studies were included if they reported on working-age adults with overweight or obesity and measured absenteeism, presenteeism, or work disability in a European setting. Studies were characterized on country, sample size, productivity construct, measurement instrument, and whether reported effect sizes are directly transferable as health economic model inputs (e.g., productivity loss fractions, excess days lost, or attributable costs).
RESULTS: From 408 records screened, 43 studies were included, representing 14 European countries. Twenty-eight studies addressed absenteeism, 8 presenteeism, and 12 work disability. For absenteeism, five studies reported transferable excess days, ranging from +3.5 to +14 days per year for employees with obesity versus normal weight. For presenteeism, no study reported a productivity loss fraction directly usable as a model input. For disability, six studies reported hazard ratios (1.35-3.04) but none reported attributable costs. Overall, only 8 of 43 studies reported effect sizes directly transferable to health economic models, nearly all concerning absenteeism.
CONCLUSIONS: A critical evidence gap exists for presenteeism: no European study reports a transferable productivity loss fraction. More broadly, while obesity's negative impact on workplace productivity is well established, the European evidence base remains insufficient for health economic modelling; particularly relevant where societal-perspective analyses are required for reimbursement. Until addressed, economic evaluations will rely on assumptions rather than evidence for their most impactful indirect cost component.