Impact of including productivity costs in economic analyses of vaccines for C. difficile infections and infant respiratory syncytial virus, in a UK setting.

OBJECTIVES: It has been estimated that vaccines can accrue a relatively large part of their value from patient and carer productivity. Yet, productivity value is not commonly or consistently considered in health economic evaluations of vaccines in several high-income countries. To contribute to a better understanding of the potential impact of including productivity value on the expected cost-effectiveness of vaccination, we illustrate the extent to which the incremental costs would change with and without productivity value incorporated. METHODS: For two vaccines currently under development, one against Cloistridioides difficile (C. difficile) infection and one against respiratory syncytial disease (RSV), we estimated their incremental costs with and without productivity value included and compared the results. RESULTS: In this analysis, reflecting a UK context, a C. difficile vaccination programme would prevent £12.3 in productivity costs for every person vaccinated. An RSV vaccination programme would prevent £49 in productivity costs for every vaccinated person. CONCLUSIONS: Considering productivity costs in future cost-effectiveness analyses of vaccines for C. difficile and RSV will contribute to better-informed reimbursement decisions from a societal perspective.

The Economic Burden of Vision Loss and Blindness in the United States.

PURPOSE: To estimate the economic burden of vision loss (VL) in the United States and by state. DESIGN: Analysis of secondary data sources (American Community Survey [ACS], American Time Use Survey, Bureau of Labor Statistics, Medical Expenditure Panel Survey [MEPS], National and State Health Expenditure Accounts, and National Health Interview Survey [NHIS]) using attributable fraction, regression, and other methods to estimate the incremental direct and indirect 2017 costs of VL. PARTICIPANTS: People with a yes response to a question asking if they are blind or have serious difficulty seeing even when wearing glasses in the ACS, MEPS, or NHIS. MAIN OUTCOME MEASURES: We estimated the direct costs of medical, nursing home (NH), and supportive services and the indirect costs of absenteeism, lost household production, reduced labor force participation, and informal care by age group, sex, and state in aggregate and per person with VL. RESULTS: We estimated an economic burden of VL of $134.2 billion: $98.7 billion in direct costs and $35.5 billion in indirect costs. The largest burden components were NH ($41.8 billion), other medical care services ($30.9 billion), and reduced labor force participation ($16.2 billion), all of which accounted for 66% of the total. Those with VL incurred $16 838 per year in incremental burden. Informal care was the largest burden component for people 0 to 18 years of age, reduced labor force participation was the largest burden component for people 19 to 64 years of age, and NH costs were the largest burden component for people 65 years of age or older. New York, Connecticut, Massachusetts, Rhode Island, and Vermont experienced the highest costs per person with VL. Sensitivity analyses indicate total burden may range between $76 and $218 billion depending on the assumptions used in the model. CONCLUSIONS: Self-reported VL imposes a substantial economic burden on the United States. Burden accrues in different ways at different ages, leading to state differences in the composition of per-person costs based on the age composition of the population with VL. Information on state variation can help local decision makers target resources better to address the burden of VL.

Patients' productivity losses and informal care costs related to ischemic stroke: a French population-based study.

BACKGROUND AND PURPOSE: Large societal costs of stroke should not be ignored. We aimed to estimate patients' productivity losses and informal care costs during the first year after ischemic stroke. METHODS: A cross-sectional survey was performed within the STROKE69 regional population-based cohort study. At 1 year post-stroke, each patient and the corresponding main informal caregiver received questionnaires followed by a telephone interview if necessary. Time losses were valued using the human capital approach and proxy good method for patients with and without a professional activity, respectively. RESULTS: Among the 222 patients with ischemic stroke (58% men; mean age 68 years; and 86% with a modified Rankin Scale (mRS) score of <3 at 3 months), 54%, 32%, and 25% received informal, formal, and both cares, respectively. Among the 108 main informal caregivers, 63% were women, 74% lived with the patient, and 57% were retired or unemployed. The mean cost of productivity losses was estimated at €7589 ± €12 305 per patient in the first post-stroke year with 5.4%, 71.2%, and 23.4% of these being attributed to presenteeism, absenteeism, and leisure time, respectively. Informal care was given at an average of 25 h/week. The annual mean estimated total cost of informal care was €10 635 per caregiver. CONCLUSIONS: Informal care and productivity losses of patients with ischemic stroke during the first post-stroke year represent a significant economic burden for society comparable to direct costs. These costs should be included in economic evaluations with the adoption of a societal perspective to avoid underestimating the societal stroke economic burden.

Can the Consideration of Societal Costs Change the Recommendation of Economic Evaluations in the Field of Rare Diseases? An Empirical Analysis.

OBJECTIVES: To analyze whether the adoption of a societal perspective would alter the results and conclusions of economic evaluations for rare disease-related healthcare technologies. METHODS: A search strategy involving all the active substances considered as orphan drugs by the European Medicines Agency plus a list of 76 rare diseases combined with economic-related terms was conducted on Medline and the Cost-Effectiveness Registry from the beginning of 2000 until November 2018. We included studies that considered quality-adjusted life years as an outcome, were published in a scientific journal, were written in English, included informal care costs or productivity losses, and separated the results according to the applied perspective. RESULTS: We found 14 articles that fulfilled the inclusion criteria. Productivity losses were considered in 12 studies, the human capital approach being the method most frequently used. Exclusively, informal care was considered in 2 articles, being valued through the opportunity cost method. The 14 articles selected resulted in 26 economic evaluation estimations, from which incremental cost-utility ratio values changed from cost-effective to dominant in 3 estimates, but the consideration of societal costs only modified the authors' conclusion in 1 study. CONCLUSIONS: The presence of societal costs in the economic evaluation of rare diseases did not affect the conclusions of the studies except in a single specific case. In those studies where the societal perspective was considered, we did not find significant changes in the economic evaluation results due to the higher costs of treatments and the low quality-adjusted life-years gained.

The economic costs of child maltreatment in UK.

Child maltreatment is a major public health problem with significant consequences for individual victims and for society. In this paper, we quantify for the first time the economic costs of fatal and nonfatal child maltreatment in the UK in relation to several short-, medium-, and long-term outcomes ranging from physical and mental health problems to labor market outcomes and welfare use. We combine novel regression analysis of rich data from the National Child Development Study and the English Longitudinal Study of Aging with secondary evidence to produce an incidence-based estimate of the lifetime costs of child maltreatment from a societal perspective. The discounted average lifetime incidence cost of nonfatal child maltreatment by a primary caregiver is estimated at £89,390 (95% uncertainty interval £44,896 to £145,508); the largest contributors to this are costs from social care, short-term health, and long-term labor market outcomes. The discounted lifetime cost per death from child maltreatment is estimated at £940,758, comprising health care and lost productivity costs. Our estimates provide the first comprehensive benchmark to quantify the costs of child maltreatment in the UK and the benefits of interventions aimed at reducing or preventing it.

Economic evaluation of interventions to reduce solar ultraviolet radiation (UVR) exposure among construction workers.

Solar ultraviolet radiation is one of the most common occupational carcinogens in Canada and is responsible for approximately 5,556 non-melanoma skin cancers per year. A large part of these cases are preventable by reducing solar ultraviolet radiation exposure. In this study, investigators estimated the potential economic impacts of different solar ultraviolet radiation reduction interventions among construction workers, as they are one of the largest at-risk occupational groups. Investigators performed an economic evaluation from a societal perspective, by comparing incremental costs in relation to incremental benefits achieved by two interventions-use of personal protective equipment by all exposed individuals and use of shade structure wherever and whenever feasible. Interventions costs were estimated for 2020-2050, and benefits with a 10-year delay, i.e., for the period 2030-2060. Economic evaluation estimates were reported by intervention costs, total costs of non-melanoma skin cancers cases averted, incremental cost per avert case, return on investment, and the break-even point. Various sensitivity analyses were undertaken with key parameters. Our findings indicate that if the rising trend of incidence continues, cases will be double in 2060, whereas by using personal protective equipment or shade structure, with the best-case scenario of full ultraviolet radiation removal, would result in 6,034 and 2,945 cases averted over 30 years, respectively. This translates into a total of $38.0 and $20.5 million of averted costs (all monetary values represented in 2017 Canadian dollars). Under this scenario investigators expect that by 2060, for every dollar invested in personal protective equipment and shade structures, $0.49 and $0.35 will be returned, respectively. Findings also suggested that under a conservative scenario, prevention of non-melanoma skin cancer cases by personal protective equipment and shade structures resulted in $5,812 and $7,355 incremental costs, respectively, over the 30-year period. This study provides important insights for decision makers about the potential impacts of solar ultraviolet radiation reduction interventions in the construction sector and other sectors with substantial outdoor work. Our estimates also can raise awareness of the importance of solar ultraviolet radiation reduction interventions.

Productivity costs from a dengue episode in Asia: a systematic literature review.

BACKGROUND: Dengue is a mosquito-borne viral infection which has been estimated to cause a global economic burden of US$8.9 billion per year. 40% of this estimate was due to what are known as productivity costs (the costs associated with productivity loss from both paid and unpaid work that results from illness, treatment or premature death). Although productivity costs account for a significant proportion of the estimated economic burden of dengue, the methods used to calculate them are often very variable within health economic studies. The aim of this review was to systematically examine the current estimates of the productivity costs associated with dengue episodes in Asia and to increase awareness surrounding how productivity costs are estimated. METHOD: We searched PubMed and Web of Knowledge without date and language restrictions using terms related to dengue and cost and economics burden. The titles and abstracts of publications related to Asia were screened to identify relevant studies. The reported productivity losses and costs of non-fatal and fatal dengue episodes were then described and compared. Costs were adjusted for inflation to 2017 prices. RESULTS: We reviewed 33 relevant articles, of which 20 studies reported the productivity losses, and 31 studies reported productivity costs. The productivity costs varied between US$6.7-1445.9 and US$3.8-1332 for hospitalized and outpatient non-fatal episodes, respectively. The productivity cost associated with fatal dengue episodes varied between US$12,035-1,453,237. A large degree of this variation was due to the range of different countries being investigated and their corresponding economic status. However, estimates for a given country still showed notable variation. CONCLUSION: We found that the estimated productivity costs associated with dengue episodes in Asia are notable. However, owing to the significant variation in methodology and approaches applied, the reported productivity costs of dengue episodes were often not directly comparable across studies. More consistent and transparent methodology regarding the estimation of productivity costs would help the estimates of the economic burden of dengue be more accurate and comparable across studies.

Patient costs of diabetes mellitus care in public health care facilities in Kenya.

OBJECTIVE: To estimate the direct and indirect costs of diabetes mellitus care at five public health facilities in Kenya. METHODS: We conducted a cross-sectional study in two counties where diabetes patients aged 18 years and above were interviewed. Data on care-seeking costs were obtained from 163 patients seeking diabetes care at five public facilities using the cost-of-illness approach. Medicines and user charges were classified as direct health care costs while expenses on transport, food, and accommodation were classified as direct non-health care costs. Productivity losses due to diabetes were classified as indirect costs. We computed annual direct and indirect costs borne by these patients. RESULTS: More than half (57.7%) of sampled patients had hypertension comorbidity. Overall, the mean annual direct patient cost was KES 53 907 (95% CI, 43 625.4-64 188.6) (US$ 528.5 [95% CI, 427.7-629.3]). Medicines accounted for 52.4%, transport 22.6%, user charges 17.5%, and food 7.5% of total direct costs. Overall mean annual indirect cost was KES 23 174 (95% CI, 20 910-25 438.8) (US$ 227.2 [95% CI, 205-249.4]). Patients reporting hypertension comorbidity incurred higher costs compared with diabetes-only patients. The incidence of catastrophic costs was 63.1% (95% CI, 55.7-70.7) and increased to 75.4% (95% CI, 68.3-82.1) when transport costs were included. CONCLUSION: There are substantial direct and indirect costs borne by diabetic patients in seeking care from public facilities in Kenya. High incidence of catastrophic costs suggests diabetes services are unaffordable to majority of diabetic patients and illustrate the urgent need to improve financial risk protection to ensure access to care.

Healthcare costs and productivity losses associated with county-based home-care service for sick children in Sweden.

AIMS: The aim of this study was to estimate the healthcare costs and productivity losses associated with county-based home-care services (HCS) for sick children. METHODS: In this observational follow-up study, a combination of hospital care and HCS was compared to estimated alternative care solely at the hospital. Data on one year of healthcare utilisation for 32 children, supplied by the hospital and HCS, were collected from administrative systems. Corresponding healthcare unit prices were collected from healthcare pricelists. The human-capital approach was applied to estimate productivity losses and the value of productivity losses for 25 parents. Family characteristics, including parental work absenteeism and income, were collected by a questionnaire distributed to parents at five time points during a year. Descriptive and comparative statistics were used for analysis and carried out with ethical approval. RESULTS: Healthcare costs for children receiving a combination of hospital care and HCS varied among children with estimated average healthcare cost savings of SEK 50 101 per child compared to the alternative of care provided only in the hospital. The reduced costs were related to children receiving nonpalliative HCS care tasks. Average annual productivity losses due to parental work absenteeism were estimated at 348 hours with an associated monetary value estimated at SEK 137 524 per parent. CONCLUSION: County-based HCS, provided as complement to and substitute for hospital care for ill children, does not increase healthcare cost and should be a prioritized area when organising paediatric health care. Productivity losses vary greatly among parents and are pronounced also when children receive HCS with signs of gender-related differences.

Productivity losses associated with premature mortality due to cancer in Russia: A population-wide study covering 2001-2030.

Aims: Productivity losses related to premature cancer mortality have been assessed for most developed countries but results for Russia are limited to cross-sectional reports. The aim of this study was to quantify productivity costs due to cancer mortality in Russia between 2001 and 2015 and project this to 2030. Methods: Cancer mortality data (2001-2015) were acquired from the State Cancer Registry, whereas population data, labour force participation rates and annual earnings were retrieved from the Federal State Statistics Service. Cancer mortality was projected to 2030 and the human capital approach was applied to estimate productivity losses. Results: The total annual losses increased from US6.5b in 2001-2005 to US$8.1b in 2011-2015, corresponding to 0.24% of the annual gross domestic product. The value is expected to remain high in 2030 (US$7.5b, 0.14% of gross domestic product). Productivity losses per cancer death are predicted to grow faster in women (from US$18,622 to US$22,386) than in men (from US$25,064 to US$28,459). Total losses were found to be highest for breast cancer in women (US$0.6b, 20% of overall losses in women) and lung cancer in men (US$1.2b, 24%). The absolute predicted change of annual losses between 2011-2015 and 2026-2030 was greatest for cervix uteri (+US$214m) in women and for lip, oral and pharyngeal cancers in men (+US$182m). Conclusions: In Russia, productivity losses due to premature cancer mortality are substantial. Given the expected importance especially for potentially preventable cancers, steps to implement effective evidence-based national cancer control policies are urgently required.

Labour productivity loss caused by premature deaths associated with breast cancer: results from Spain over a 10-year period.

BACKGROUND: Breast cancer is one of the most common cancers among women worldwide, and is the most common cause of cancer deaths in them. Given that such disease has a significant impact on middle-aged women, it can result in considerable labour productivity losses. The main objective of this study is therefore to analyse labour productivity losses and years of potential working life lost as a result of premature deaths from breast cancer in Spain over a 10-year period (2005-2014). METHOD: To this end, by combining data on average salary (Salary Structure Survey), occupation (Active Population Survey) and deaths (death registration according to cause of death), a simulation model based on the human capital approach was constructed to estimate productivity losses associated with premature deaths caused by this disease. RESULTS: The results reveal that labour productivity losses in women are estimated to cost 2,137 million euros, as a result of the 22,716 deaths occurring during working age and the 292,848 years of potential productive life lost. This implies that breast cancer is responsible for 10.45% of all estimated female labour productivity losses caused by premature deaths in the reference year. CONCLUSION: The article concludes by highlighting the major economic impact associated with breast cancer deaths and by pointing out future research areas.

Impact of ledipasvir/sofosbuvir on the work productivity of genotype 1 chronic hepatitis C patients in Asia.

Chronic, untreated hepatitis C virus (HCV) infection is associated with a poor clinical prognosis and a detrimental impact on patients' lives, including on work productivity. To estimate the value of productivity losses due to genotype 1 (GT1) HCV infection in Hong Kong, Singapore, South Korea and Taiwan and to estimate the potential productivity gains associated with treating patients with ledipasvir/sofosbuvir (LDV/SOF) therapy, an economic model was developed with a time horizon of 1 year. Hepatitis C virus patients entered the model at 12 weeks post-treatment, having achieved or not achieved sustained virological response (SVR). Absenteeism and presenteeism rates were taken from a pooled analysis of data from the ION 1-3 studies. These rates were converted into hours of lost productivity, multiplied by the average wage and applied to the total employed, adult GT1 population in each country. Results were compared assuming no treatment, and assuming all patients were treated with LDV/SOF. Total productivity losses due to untreated HCV were: $11.3 million, $17.1 m, $146.0 m and $349.1 m in Hong Kong, Singapore, South Korea and Taiwan. LDV/SOF treatment resulted in economic gains of $4.5 m, $6.8 m, $58.7 m and $138 m, respectively. These gains were due to reduced presenteeism. The results were sensitive to changes in the prevalence of HCV and the average wage. In conclusion, productivity losses due to untreated HCV infection represent a substantial economic burden. By instituting universal HCV treatment with LDV/SOF (or other therapies with high SVR rates), productivity gains can be achieved.

Indirect costs and public finance consequences of heart failure in Poland, 2012-2015.

BACKGROUND: As a consequence of unfavourable epidemiological trends and the development of disease management, the economic aspects of heart failure (HF) have become more and more important. The costs of treatment (direct costs) appear to be the most frequently addressed topic in the economic research on HF; however, less is known about productivity losses (indirect costs) and the public finance burden attributable to the disease. Therefore, the aim of this study was to estimate the indirect costs and public finance consequences of HF in Poland in the period 2012-2015. METHODS: The study uses a societal perspective and a prevalence-based top-down approach to estimate the following components of HF indirect costs: absenteeism of the sick and their caregivers, presenteeism of the sick, disability, and premature mortality. The human capital method has been chosen to identify the value of productivity losses attributable to HF and the public finance consequences of the disease. Deterministic sensitivity analysis was performed to assess the robustness of the results. RESULTS: The total indirect costs of HF in Poland were €871.9 million in 2012, and they increased to €945.3 million in 2015. In the period investigated, these costs accounted for 0.212-0.224% of GDP, an equivalent of 22.63€-24.59€ per capita. Mortality proved to be the main driver of productivity losses, with 59.3-63.4% of the total costs depending on year, followed by presenteeism (21.1-22.5%), disability (11.1-14.2%) and the sick's absenteeism (3.3-4.0%). The cost of caregivers' absenteeism was unimportant. The social insurance expenditure for benefits associated with HF accounted for €40.7 million in 2012 and €45.6 million in 2015 (0.56-0.59% expenditure for all diseases). The potential public revenue losses associated with HF were €262.7-€287.9 million. Sensitivity analysis showed that the costs varied by - 12.1% to + 28.8% depending on the model parameter values. CONCLUSION: HF is a substantial burden on the economy and public finance in Poland. By confronting the disease more effectively, the length and quality of life for those affected by HF could be improved, but society as a whole could also benefit from the increased economic output.

HIV-positive pregnant women attending the prevention of mother-to-child transmission of HIV/AIDS (PMTCT) services in Ethiopia: economic productivity losses across urban-rural settings.

HIV/AIDS impacts significantly on pregnant women and on children in Ethiopia. This impact has a multiplier effect on household economies and on productivity losses, and is expected to vary across rural and urban settings. Applying the human capital approach to data collected from 131 respondents, this study estimated productivity losses per HIV-positive pregnant woman-infant pair across urban and rural health facilities in Ethiopia, which in turn were used to estimate the national productivity loss. The study found that the annual productivity loss per woman-infant pair was Ethiopian birr (ETB) 7,433 or United States dollar (US$) 378 and ETB 625 (US$ 32) in urban and rural settings, respectively. The mean patient days lost per year due to inpatient admission at hospitals/health centres was 11 in urban and 22 in rural health facilities. On average, urban home care-givers spent 20 (SD = 21) days annually providing home care services, while their rural counterparts spent 23 days (SD = 26). The productivity loss accounted for 16% and 7% of household income in urban and rural settings, respectively. These high and varying productivity losses require preventive interventions that are appropriate to each setting to ensure the welfare of women and children in Ethiopia.

Productivity losses and public finance burden attributable to breast cancer in Poland, 2010-2014.

BACKGROUND: Apart from the health and social burden of the disease, breast cancer (BC) has important economic implications for the sick, health system and whole economy. There has been a growing interest in the economic aspects of breast cancer and analyses of the disease costs seem to be the most explored topic. However, the results from these studies are hardly comparable. With this study we aim to contribute to the field by providing estimates of productivity losses and public finance burden attributable to BC in Poland. METHODS: We used retrospective prevalence-based top-down approach to estimate the productivity losses (indirect costs) of BC in Poland in the period 2010-2014. Human capital method (HCM) and societal perspective were used to estimate the costs of: absenteeism of the sick and caregivers, presenteeism of the sick and caregivers, disability, and premature mortality. We also used figures illustrating public finance burden attributable to the disease. Deterministic sensitivity analysis was performed to assess the stability of the estimates. A variety of data sources were used with the social insurance system and Polish National Cancer Registry being the most important ones. RESULTS: Productivity losses associated with BC in Poland were €583.7 million in 2010 and they increased to €699.7 million in 2014. Throughout the period these costs accounted for 0.162-0.171% of GDP, an equivalent of 62,531-65,816 per capita GDP. Losses attributable to disability and premature mortality proved to be the major cost drivers with 27.6%-30.6% and 22.0%-24.6% of the total costs respectively. The costs due to caregivers' presenteeism were negligible (0.1% of total costs). Public finance expenditure for social insurance benefits to BC sufferers ranged from €50.2 million (2010) to €56.6 million (2014), an equivalent of 0.72-0.79% of expenditures for all diseases. Potential losses in public finance revenues accounted for €173.9 million in 2010 and €211.0 million in 2014. Sensitivity analysis showed that the results were robust to changes in the model parameters. CONCLUSIONS: The productivity losses attributable to BC in Poland were a sizable burden for the society. They contributed both to decreased economy output and to public finance deficit.

Cost-of-Illness in Rare Diseases.

Cost-of-illness (COI) studies quantify the economic burden of a disease, including direct healthcare and non-healthcare costs and productivity losses. Different approaches can be adopted to evaluate the resources associated to a disease and to calculate the total costs. Prevalence-based studies estimate the total costs of a disease during a given period, while incidence-based studies measure lifetime costs from onset until death. Data can be collected from individuals, using a bottom-up approach, or from population statistics, using a top-down approach. Different perspectives are possible, but the broadest and also mostly used is the societal one. Appropriate discounting should be applied for future costs and a sensitivity analyses of main parameters should be performed. The main limitation of COI studies is that they don't account the outcomes or benefits of possible treatments.There is a lack of COI studies in the field of rare diseases. A multinational COI study (BURQOL-RD) evaluated recently the burden of 10 rare diseases in Europe, using a prevalence-based method with a bottom-up approach to quantify resources from a societal perspective, which is the mostly used methodology for COI studies in rare diseases; however, several other studies illustrate different approaches to conduct COI analysis in this field, such as incidence-based methods or narrower perspectives.COI studies are useful to inform policy-makers about the magnitude of a disease. To support correctly the decision-making process, it is necessary to identify the cost-drivers through COI studies with robust design and standardized methodology.

Long-term economic consequences of child maltreatment: a population-based study.

Child maltreatment is prognostically associated with long-term detrimental consequences for mental health. These consequences are reflected in higher costs due to health service utilization and productivity losses in adulthood. An above-average sense of mastery can have protective effects in the pathogenesis of mental disorders and thus potentially cushion adverse impacts of maltreatment. This should be reflected in lower costs in individuals with a history of child maltreatment and a high sense of mastery. The aims of the study were to prognostically estimate the excess costs of health service uptake and productivity losses in adults with a history of child maltreatment and to evaluate how mastery may act as an effect modifier. Data were used on 5618 individuals participating in the Netherlands Mental Health Survey and Incidence Study (NEMESIS). We focussed on measures of child maltreatment (emotional neglect, physical, psychological and sexual abuse) and economic costs owing to health-care uptake and productivity losses when people with a history of abuse have grown into adulthood. We evaluated how mastery acted as an effect modifier. Estimates were adjusted for demographics and parental psychopathology. Post-stratification weights were used to account for initial non-response and dropout. Due to the non-normal distribution of the costs data, sample errors, 95 % confidence intervals, and p values were calculated using non-parametric bootstrapping (1000 replications). Exposure to child maltreatment occurs frequently (6.9-24.8 %) and is associated with substantial excess costs in adulthood. To illustrate, adjusted annual excess costs attributable to emotional neglect are €1,360 (95 % CI: 615-215) per adult. Mastery showed a significant effect on these figures: annual costs were €1,608 in those with a low sense of mastery, but only €474 in those with a firmer sense of mastery. Child maltreatment has profound mental health consequences and is associated with staggering long-term economic costs, rendering lack of action very costly. Our data lends credibility to the hypothesis that mastery may help to cushion the adverse consequences of child maltreatment. Further research on mastery may help to ameliorate individual burden and in addition offer some economic benefits.

The iMTA Productivity Cost Questionnaire: A Standardized Instrument for Measuring and Valuing Health-Related Productivity Losses.

BACKGROUND: Productivity losses often contribute significantly to the total costs in economic evaluations adopting a societal perspective. Currently, no consensus exists on the measurement and valuation of productivity losses. OBJECTIVE: We aimed to develop a standardized instrument for measuring and valuing productivity losses. METHODS: A group of researchers with extensive experience in measuring and valuing productivity losses designed an instrument suitable for self-completion, building on preknowledge and evidence on validity. The instrument was designed to cover all domains of productivity losses, thus allowing quantification and valuation of all productivity losses. A feasibility study was performed to check the questionnaire's consistency and intelligibility. RESULTS: The iMTA Productivity Cost Questionnaire (iPCQ) includes three modules measuring productivity losses of paid work due to 1) absenteeism and 2) presenteeism and productivity losses related to 3) unpaid work. Questions for measuring absenteeism and presenteeism were derived from existing validated questionnaires. Because validated measures of losses of unpaid work are scarce, the questions of this module were newly developed. To enhance the instrument's feasibility, simple language was used. The feasibility study included 195 respondents (response rate 80%) older than 18 years. Seven percent (n = 13) identified problems while filling in the iPCQ, including problems with the questionnaire's instructions and routing (n = 6) and wording (n = 2). Five respondents experienced difficulties in estimating the time that would be needed for other people to make up for lost unpaid work. CONCLUSIONS: Most modules of the iPCQ are based on validated questions derived from previously available instruments. The instrument is understandable for most of the general public.

Use of Stroke-Related Income Supplements and Predictors of Use in a Working-Aged Finnish Ischemic Stroke Cohort.

BACKGROUND: Compared with the direct costs, the indirect costs of stroke may be larger contributors to the socioeconomic burden of stroke, and the need to better understand the indirect costs of stroke is well established. We investigated the indirect costs of stroke according to a novel outcome, the use of stroke-related income supplements, in a Finnish cohort of working-aged patients. METHODS: Consecutive patients (n = 230) who experienced a first-ever ischemic stroke were recruited. Demographic, clinical, and cognitive function data (which were measured using clinical neuropsychological assessments) were collected at baseline and at 6-month and 2-year follow-ups. Data on the use of income supplements within the first 3 years of the stroke were retrieved from national insurance registry files and used to construct survival models. RESULTS: Stroke patients used a mean of 11 months of stroke-related income supplements; this use was associated with atrial fibrillation, cognitive impairment, prestroke income supplement use, higher National Institutes of Health Stroke Scale scores, lower Barthel Index scores, and increased lesion sizes. In multivariate survival models, atrial fibrillation and cognitive impairment were the factors most strongly associated with the use of stroke-related income supplements. CONCLUSIONS: Using stroke-related income supplement data to quantify poststroke productivity losses allowed a working-aged cohort to be investigated without inclusion restrictions based on occupational status or other factors; the use of these data as an outcome emphasized the well-known detrimental effects of atrial fibrillation and cognitive impairment on stroke outcome. The results support stroke-related income supplement use as a complementary outcome for understanding stroke-related productivity losses.

Do the Washington Panel recommendations hold for Europe: investigating the relation between quality of life versus work-status, absenteeism and presenteeism.

BACKGROUND: The question of how to value lost productivity in economic evaluations has been subject of debate in the past twenty years. According to the Washington panel, lost productivity influences health-related quality of life and should thus be considered a health effect instead of a cost to avoid double counting. Current empirical evidence on the inclusion of income loss when valuing health states is not decisive. We examined the relationship between three aspects of lost productivity (work-status, absenteeism and presenteeism) and patient or social valuation of health-related quality of life (HRQoL). METHODS: Cross-sectional survey data were collected from a total of 830 respondents with a rheumatic disorder from four West-European countries. Health-related quality of life was expressed in either the European societal utility using EQ-5D-3L or the patient valuation using EQ-VAS. The impact of work-status (four categories), absenteeism (absent from paid work during the past three months), and presenteeism (QQ method) on EQ-5D utilities and VAS scores was examined in linear regression analyses taking into account demographic characteristics and disease severity (duration, pain and restriction). RESULTS: The relationship between work-status, absenteeism or presenteeism and HRQoL was stronger for patient valuation than societal valuation. Compared to work-status and presenteeism the relationship between absenteeism and HRQoL was even less explicit. However, results for all measures of lost productivity are only marginally significant and negligible compared to the influence of disease-related restrictions. CONCLUSIONS: This survey study in patients with a rheumatic disorder in four European countries, does not fully support the Washington panel's claim that lost productivity is a significantly related with HRQoL, and this is even more apparent for absenteeism than for work-status and presenteeism. For West-European countries, there is no reason, to include absenteeism in the QALY. Findings need to be confirmed in other disease areas.