OBJECTIVES: This study systematically reviews cost-effectiveness analyses (CEA) of drugs that included productivity-related costs. The types of cost elements included and the calculation methods used are summarized. Moreover, differences in the method of calculating productivity-related costs are examined by disease, geographic region, period of analysis, impact on cost-effectiveness, and more.

METHODS: A search of MEDLINE, Embase, and the Cochrane library databases was performed to identify CEA that included productivity-related costs. Publications conducted from January 2010 to October 2019 were examined for inclusion. In addition to the citation details, data on the study origin, design characteristics, and detailed data on the approach to including productivity-related costs were extracted. Moreover, their impact on cost-effectiveness was examined.

RESULTS: The search strategy identified 5,038 unique studies and 208 were included in the final analysis. Productivity cost elements included in the analysis were reported for 169 studies (81%). Absenteeism only was included for 98 studies (47%) and absenteeism plus presenteeism was included for 29 studies (14%). Absenteeism plus some other element such as costs related to unemployment and/or early retirement was included for 32 studies (15%). Only one out of four of the studies reviewed included information on the approach used to estimate productivity costs which was predominantly the human capital approach. One-hundred and forty-four studies (69%) reported the impact of including productivity-related costs on cost-effectiveness, with 102 studies (49%) reporting a favorable impact.

CONCLUSIONS: Although inclusion of productivity costs was shown to have a favorable impact on cost-effectiveness for many studies, their impact and method of calculation used was often not reported. Further examination and discussion is needed to consider the optimal framework for considering productivity losses / gains in CEA.