OBJECTIVES: Health technology assessment (HTA), including cost-effectiveness analysis (CEA), contributes to the development of equitable, efficient, and high-quality health care systems. The costs considered in CEA may vary depending on the particular health care systems in countries and regions (hereinafter collectively referred to as “countries”). This study aimed to summarize the differences in perspectives and consideration of productivity losses in each country.

METHODS: We conducted a qualitative review of the guidelines relevant to CEA in European and Asian countries and classified the recommended perspectives of guidelines into the payer’s perspective [A], societal perspective [B], specific perspective other than the payer’s or the societal perspectives [C], and multiple perspective [D] categories. In addition, we analyzed the descriptions of productivity losses for patients and caregivers as well as absenteeism and presenteeism.

RESULTS: A total of 33 countries were surveyed, including 25 European and 8 Asian countries. In these countries, 19 (57.6%; 19/33), 8 (24.2%; 8/33), 2 (6.1%; 2/33), and 4 (12.1%; 4/33) guidelines recommended categories A, B, C, and D, respectively, when performing a base case analysis. Of guidelines excluding category A, all (100.0%; 14/14) mentioned patients’ productivity losses, of which 9 (64.3%; 9/14) also addressed caregivers’ productivity losses. Absenteeism and presenteeism were clearly stated in 6 guidelines (42.9%; 6/14), whereas only absenteeism was included in 5 guidelines (35.7%; 5/14). The remaining 3 guidelines (21.4%; 3/14) did not mention the inclusion of absenteeism and presenteeism.

CONCLUSIONS: The recommended perspectives and consideration of productivity loss as reflected in guidelines vary widely across the examined countries. Descriptions regarding productivity loss in the guidelines and background information on health care systems in each country should be comprehensively considered to understand the results of CEA.