OBJECTIVES : There is variation between jurisdictions in the guidance from public drug reimbursement agencies as to the perspective of the economic evaluation. Some jurisdictions require pharmaceutical manufacturers to adopt a payer perspective, meaning that only direct medical costs healthcare (e.g., hospitalization, physician case, and medications) are considered. In other jurisdictions a societal perspective for economic submissions is required, meaning that lost productivity costs are also included in the evaluation. As chronic health conditions have often high demands for informal care that risk depleting household resources, lost productivity for these conditions is expected to be large. The impact of illness on work productivity can be measured in terms of four components: absenteeism (absence from work), presenteeism (reduced performance and productivity while working), job loss, and time loss from normal activity. The goal here was to derive estimates from the peer-reviewed literature on the impact of chronic health conditions on work productivity and absenteeism.

METHODS : We undertook a literature review of contemporary studies of lost productivity in cancer, anemia, kidney disease, and rare diseases.

RESULTS : For cancer (seven studies), anemia and blood disorders (seven studies), kidney diseases (six studies), and rare diseases (four studies), per capita absenteeism ranged from 23 to 102 days, per capita presenteeism ranged from 72 to 86 days, per capita productivity loss ranged from 84 to 139 days, per capita activity impairment ranged from 82 to 121 days, and per capita productivity losses range between US$40,000 and $146,000. Due to the severity of the disease, productivity loss is greatest for cancer (mean = 139 days), as are missed work/school days (mean = 109 days), activity impairment (mean = 121 days), and the resulting monetary value of productivity loss (mean = $146,604).

CONCLUSIONS : Productivity losses for many chronic diseases are substantial and can surpass direct medical costs.