Advancing Lost Productivity Measurement in Economic Evaluations: Evidence Priorities from a Targeted Literature Review and Expert Workshop.

backgroundProductivity losses from illness, treatment, and informal caregiving impose a substantial economic burden on patients, caregivers, employers, and society in the United States (US), but measurement remains inconsistent and often omits key domains, such as presenteeism and unpaid non-market work productivity. These gaps limit the integration of productivity into economic evaluations and policy and may lead to undervaluation of interventions that improve health and reduce disease burden.

objectiveThe aim was to identify evidence priorities and methodological improvements for measuring and valuing productivity in US economic evaluations.

methodsA targeted literature review (TLR) of US-based studies published from 2020 to 2024 was conducted to evaluate measurement of absenteeism, presenteeism, or unpaid non-market work productivity. Definitions, instruments, valuation methods, and reporting practices were extracted. Findings informed a virtual workshop with eight stakeholders, who completed prioritization exercises and participated in facilitated discussions to refine evidence priorities and methodological recommendations.

resultsThirty studies met the TLR inclusion criteria. Absenteeism was assessed in 77%, unpaid non-market work productivity in 67%, and presenteeism in 37%. The Work Productivity and Activity Impairment questionnaire was used in 40%. Only 30% assessed informal caregiving-related productivity losses, 23% included fringe benefits, and 37% used longitudinal designs. In the workshop, stakeholders prioritized four predefined domains for future evidence generation and value assessment: (1) measuring longitudinal fluctuations in productivity by disease severity; (2) valuing unpaid non-market work productivity; (3) measuring presenteeism; and (4) disaggregating productivity by job types and wfork environments. Recommendations included transparent, perspective-specific valuation; capturing total compensation in absenteeism costs; disaggregating time-based and monetary outcomes; and developing instruments suitable for remote, hybrid, and gig work.

conclusionsProductivity losses are an underrecognized component of disease burden in the US. More consistent use of validated instruments, particularly for measuring longitudinal and unpaid non-market work productivity, may improve the reliability and policy relevance of productivity estimates.