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Presentation

Session: Posters
Room: TBA
Time: Fri 13:00-14:30

Presenter: Joce de Jong (iBMG. )

Abstract

INTRODUCTION
When guidelines for health economic evaluations prescribe that a societal perspective should be adopted, productivity costs should be included in economic evaluations. However, previous research suggests that, in practice, productivity costs are often neglected. This may bias the results of cost-effectiveness studies considerably, in particular for treatments targeted at diseases with a high incidence rate in the working population, such as depressive disorders.

OBJECTIVES
This study aims to find out whether economic evaluations for treatments of depressive disorders include productivity costs and, if so, how this is done. Furthermore, the impact of excluding productivity costs on cost-effectiveness ratios is investigated.

METHODS
A systematic literature review was performed. Included articles were reviewed to determine whether productivity costs had been included. Moreover, it was investigated whether the reviewed studies aligned with national health economic guidelines in including or excluding these costs. Next, using the studies that included productivity costs, it was determined what proportion of total costs productivity costs accounted for. Subsequently, the incremental costs excluding productivity costs were calculated and compared with the incremental costs presented in the original article, in order to analyze the impact of productivity costs on final results. Regression analysis was used to investigate the relationship between the absolute and relative height of productivity costs and the treated disease, the type of treatment as well as study characteristics, such as the time horizon used.

RESULTS
We identified 81 unique economic evaluations of treatments for adults with depressive disorders. Of these, 24 economic evaluations included productivity costs in the numerator; 6 used the friction cost approach, 18 the Human Capital approach. One study indicated to have used the Washington Panel approach to value productivity costs. Approximately 69% of the economic evaluations ignored productivity costs. Two-third of the studies complied with the national guidelines regarding productivity costs inclusion.

For the studies including productivity costs, these costs on average reflected 60% of total costs per treatment arm. Comparing total incremental costs excluding productivity costs with incremental costs including productivity costs caused the incremental costs to increase in 71% of the cases and to decrease in 26%. In 8% of the studies this decrease caused the incremental costs to change from positive to negative, therefore turning the new treatment into a cost-saving intervention. Changes ranged from a decrease of incremental costs of slightly more than 1000% to an increase of almost 37000%. The regression analyses showed that the absolute height of productivity costs was significantly associated with the average age of the patients in the study, the time horizon used in the study and the height of the direct costs. The time horizon used in the study and the type of depression under study significantly affected the relative height of productivity costs relative to the direct costs.

CONCLUSION
Most economic evaluations of treatments for depressive disorders ignore productivity costs. Country guidelines on productivity costs were followed in two-third of the studies. Recalculating incremental costs illustrates that not including these costs has a profound effect on cost-effectiveness results. It is important to be aware of this effect when comparing outcomes of studies including and excluding productivity costs. Study outcomes not including productivity costs in many cases may poorly reflect full societal costs (or savings) of an intervention. Moreover, regarding the comparison of study outcomes of studies including productivity costs it should be noted that study characteristics such as the time horizon of the study may both affect absolute height of productivity costs as well as their relative height compared to that of the direct costs.

Key Terms

Productivity costs, Effect on ICER, depression

Authors:

Marieke Krol (iBMG. iMTA) , Joce de Jong (iBMG) , Job vna Exel (iBMG. iMTA) and Werner Brouwer (iBMG. iMTA)

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