OBJECTIVES: The objective of this study was to investigate the societal costs in employed patients not able to work due to chronic, long-term, or terminal illness in Germany and France for potential inclusion in health economic models and hence influence on decision making. METHODS: Societal costs were investigated by collecting and analysing labour costs, disability benefit and home care benefits in Germany and France for employed patients. Costs were derived from publicly available literature or databases. The costs were analysed over 1, 3 and 5 year time horizons. RESULTS: The analysis showed that public costs could play an important role in health economic analyses in Germany and France. Productivity loss, disability pension and home care benefit during the first year of sickness were on average €41,224 per employed patient in Germany. It was assumed that patients did not work during the year at all. The societal costs were €44,952 in France per employed patient for the first year of sickness. The year 3 per employed patient cumulative costs in Germany and France were €144,280 and €158,464, respectively. The year 5 per employed patient cumulative costs in Germany and France were €254,205 and €271,975, respectively. CONCLUSIONS: Societal costs associated with long term sickness are not insignificant in Germany and France. Although indirect costs are currently not included as part of reimbursement criteria in Germany and France, this analysis suggests that the inclusion of these should be considered for standard health economic analyses where possible. The results are of interest when comparing two treatment regimens where patients have differing ability to work either during or after the treatment, or where a majority of patients are employed. The overall perspective could support decision making beyond assessment of clinical benefits alone.