Background When adopting a societal perspective in health economic evaluations, productivity losses contribute in a significant way to the total costs. Nevertheless, they are rarely considered. If they are considered, they mostly include paid work only, although unpaid work (e.g. housework, informal care or voluntary work) accounts for a significant proportion of people’s lifetime. Furthermore, most severe conditions onset in the age of retirement, which means that a growing proportion of patients is not active in the labor market. Practical Implications The restriction to paid work neglects the contribution of patients who are not active in the labor market, because they do not contribute to a nation’s added value in the classical notion in terms of paid work. However, if innovative therapies restore the ability to perform both paid and unpaid work, a consideration of productivity gains only with respect to paid work, underestimates the welfare maximizing contribution of unpaid work within a society. Taking a societal perspective, it is not appropriate to exclude unpaid work from evaluations, especially when a welfare maximizing decision is aspired. Recommendation To value unpaid work, first, it is important to determine the amount of time people spend for unpaid work. We propose a practical approach using time surveys to identify this amount of time. Based on this, we suggest to apply a replacement cost approach and value these specific activities with sector specific wages in monetary terms, respectively equivalent market services. Findings of clinical trials or estimations by experts constitute an adequate basis to estimate the “reconstructed” time within a patient group. Health economic evaluations taking a societal perspective should consider all relevant costs. For this reason, both paid and particularly unpaid work losses should be included. We therefore recommend to value unpaid work by using national time use surveys and sector specific wages.