OBJECTIVES

To survey expert opinion on the extent to which the likelihood of productivity loss (PL) being considered in Health Technology Assessments (HTA) correlates with (1) the identity of the loss bearer (state, employer, or employee) and (2) the influence of sick leave insurance.

METHODS

Semi-structured interviews were held with recognized experts in HTA and measurement of productivity in eight countries (USA, Canada, UK, Germany, France, Netherlands, Sweden, Norway) between August and October 2018. Based on the experts’ answers and public government information, countries were categorised into state-, employer-, or employee-borne systems and ranked comparatively by the influence of employee sick leave insurances and by the consideration of PL in HTA or economic evaluation.

RESULTS

The experts categorized the Netherlands as employer-borne; Canada, USA, and UK as employee-borne; France, Sweden, and Norway as state-borne; Germany is a mixed employer/employee-borne system. Sick leave insurance was perceived to mitigate PL effects on employees, partly absorbing long-term PL, particularly in the USA, Canada, UK and Germany. These countries disregard PL in HTA decision making. Comparing HTA assessments in (partly) employer-borne systems, the Netherlands with weak reliance on employee sick leave insurance includes PL while Germany with strong reliance on sick leave insurance excludes PL. PL is included in HTA assessents in Sweden’s state-borne and the Netherlands’ employer-borne systems, both with weak reliance on employee sick leave insurance. Norway and France have state-borne systems with very limited influence of employee sick leave insurances, in which France considers PL effects if submitted and Norway did so until 2018.

CONCLUSIONS

A qualitative correlation appears to exist between having a weak role for employee sick leave insurances and the willingness to consider PL. In HTA evaluations, the Netherlands (employer-borne) requires PL by default; in all state-borne systems except Norway (Sweden and France), PL will be considered if included.