National College of Ireland, Mayor Street, Dublin 1, Ireland.
Maynooth University, Maynooth, Ireland.
Eur J Health Econ. 2019 Dec;20(9):1399-1408. doi: 10.1007/s10198-019-01098-3. Epub 2019 Aug 23.
Standardised integration of productivity costs into health economic evaluations is hindered by equity and distributional concerns. Our aim was to explore the distributive impact of productivity cost methodological variation, describing the consequences for different groups.
527 prostate cancer survivors (2-5 years post-diagnosis) completed questions on work patterns since diagnosis. Productivity loss, categorised into temporary/permanent absenteeism, reduced hours and presenteeism, were costed in €2012. Valuation approaches included the human capital approach (HCA) and the friction cost approach (FCA), with wage multipliers (WM) applied in additional analyses. Both national and self-reported wages were used. Costs were compared across socio-demographic and economic characteristics using non-parametric tests.
The estimated base case (HCA, using national wages) total productivity cost was €44,201 per prostate cancer survivor. Permanent absenteeism accounted for the largest cost (€18,537), followed by reduced work hours (€11,130), presenteeism (€8148) and temporary absenteeism (€6386). Alternative valuation estimates ranged from - 90% (FCA: €4625) to + 82% (HCAWM: €80,485) compared to the base case and were consistently higher for self-reported wages compared to national wages. Statistically significant differences in productivity cost were found across four of the six survivor socio-demographic and economic characteristics by valuation approach, despite no significant difference in their physical unit equivalents.
Our results indicate that the distributional impact of productivity costs varies by socio-economic and demographic characteristics. We advocate that: productivity loss should be reported in physical units where possible; cost estimation should be subject to sensitivity analysis, and only where this is not feasible, that the HCA and national wages be used to value productivity loss where equity concerns are paramount.
标准化整合生产力成本到卫生经济评估中受到公平和分配问题的阻碍。我们的目的是探索生产力成本方法学变化的分配影响，描述其对不同群体的后果。
527 名前列腺癌幸存者（诊断后 2-5 年）完成了自诊断以来的工作模式问题。将生产力损失分为临时/永久性缺勤、减少工作时间和出勤，以 2012 年的欧元计价。估值方法包括人力资本法（HCA）和摩擦成本法（FCA），并在额外的分析中应用工资乘数（WM）。同时使用了国家工资和自我报告工资。使用非参数检验比较了社会人口统计学和经济特征之间的成本。
估计的基本情况（HCA，使用国家工资），每位前列腺癌幸存者的总生产力成本为 44201 欧元。永久性缺勤造成的成本最大（18537 欧元），其次是减少工作时间（11130 欧元）、出勤（8148 欧元）和临时缺勤（6386 欧元）。替代估值估计值从比基本情况低 90%（FCA：4625 欧元）到高 82%（HCAWM：80485 欧元）不等，与国家工资相比，自我报告工资的估值始终更高。尽管在物理单位等效方面没有显著差异，但在四种生存者社会人口统计学和经济特征中，有四种评估方法的生产力成本存在统计学显著差异。
我们的结果表明，生产力成本的分配影响因社会经济和人口统计学特征而异。我们主张：尽可能以物理单位报告生产力损失；成本估计应进行敏感性分析，只有在不可行的情况下，才应在公平问题至关重要的情况下，使用 HCA 和国家工资来衡量生产力损失。
