Department of Health Policy and Management, Erasmus University, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
Pharmacoeconomics. 2013 Jul;31(7):537-49. doi: 10.1007/s40273-013-0056-3.
Productivity costs occur when the productivity of individuals is affected by illness, treatment, disability or premature death. The objective of this paper was to review past and current developments related to the inclusion, identification, measurement and valuation of productivity costs in economic evaluations. The main debates in the theory and practice of economic evaluations of health technologies described in this review have centred on the questions of whether and how to include productivity costs, especially productivity costs related to paid work. The past few decades have seen important progress in this area. There are important sources of productivity costs other than absenteeism (e.g. presenteeism and multiplier effects in co-workers), but their exact influence on costs remains unclear. Different measurement instruments have been developed over the years, but which instrument provides the most accurate estimates has not been established. Several valuation approaches have been proposed. While empirical research suggests that productivity costs are best included in the cost side of the cost-effectiveness ratio, the jury is still out regarding whether the human capital approach or the friction cost approach is the most appropriate valuation method to do so. Despite the progress and the substantial amount of scientific research, a consensus has not been reached on either the inclusion of productivity costs in economic evaluations or the methods used to produce productivity cost estimates. Such a lack of consensus has likely contributed to ignoring productivity costs in actual economic evaluations and is reflected in variations in national health economic guidelines. Further research is needed to lessen the controversy regarding the estimation of health-related productivity costs. More standardization would increase the comparability and credibility of economic evaluations taking a societal perspective.
当个人的生产力受到疾病、治疗、残疾或过早死亡的影响时，就会产生生产力成本。本文的目的是回顾过去和当前与经济评估中生产力成本的纳入、识别、衡量和估值相关的发展。在对健康技术进行经济评估的理论和实践中，主要的争论集中在是否以及如何包括生产力成本，特别是与有偿工作相关的生产力成本。在过去的几十年里，这一领域取得了重要进展。除了旷工（例如在职员工的工作效率降低和同事的乘数效应）之外，还有其他重要的生产力成本来源，但它们对成本的具体影响仍不清楚。多年来已经开发出了不同的衡量工具，但哪种工具能提供最准确的估计值还没有确定。已经提出了几种估值方法。虽然实证研究表明，生产力成本最好纳入成本效益比的成本部分，但关于人力资本法还是摩擦成本法是最适合的估值方法，仍存在争议。尽管取得了进展和大量的科学研究，但在是否应将生产力成本纳入经济评估以及应采用何种方法来产生生产力成本估算方面，尚未达成共识。这种缺乏共识可能导致在实际经济评估中忽略了生产力成本，并反映在国家卫生经济指南的差异上。需要进一步研究来减少对健康相关生产力成本估算的争议。更多的标准化将提高从社会角度进行经济评估的可比性和可信度。
