Abstract
BackgroundProductivity costs result from loss of paid and unpaid work and replacements due to morbidity and mortality. They are usually assessed in health economic evaluations with human capital method (HCM) or friction cost method (FCM). The methodology for estimating lost productivity is an area of considerable debate.ObjectiveTo compare traditional and adjusted HCM and FCM productivity cost estimates among young stroke patients.MethodsThe Northern Finland Birth Cohort 1966 was followed until the age of 50 to identify all 339 stroke patients whose productivity costs were estimated with traditional, occupation-specific and adjusted HCM and FCM models by using detailed, national register-based data on care, disability, mortality, education, taxation and labour market.ResultsCompared to traditional HCM, taking into account occupational class, national unemployment rate, disability-free life expectancy and decline in work ability, the productivity cost estimate decreased by a third, from €255,960 to €166,050. When traditional FCM was adjusted for occupational class and national unemployment rate, the estimate more than doubled from €3,040 to €7,020. HCM was more sensitive to adjustments for discount rate and wage growth rate than FCM.ConclusionsThis study highlights the importance of adjustments of HCM and FCM. Routine register-based data can be used for accurate productivity cost estimates of health shocks.
Highlights
Productivity costs are costs resulting from loss of paid and unpaid work and replacement costs due to morbidity and mortality
We estimated the productivity costs (PC) as PC = wage × t × PLDF × (1 − u) × Work ability decline (WAD), where t is the time of absence, PLDF = disability-free life expectancy/life expectancy, u is the national annual unemployment rate and WAD is an estimate for overall coefficient of work ability decline
In friction cost method (FCM), the productivity costs were evaluated as length of the absence from work after a stroke multiplied with the value of daily production if absence was shorter than estimated friction period
Summary
Productivity costs are costs resulting from loss of paid and unpaid work and replacement costs due to morbidity and mortality They are usually assessed in health economic evaluations with either human capital method (HCM) or friction cost method (FCM) [1,2,3]. One major limitation is that they do not take into account differences in wage levels between occupational classes It has been highlighted in previous literature that the applied monetary values should resemble the value of lost productivity as closely as possible [14]. In both approaches, the conventional use of population mean wage might lead to overestimation of productivity costs if the disease burden were concentrated on lower socioeconomical classes. We (1) use detailed, accurate register-based data of a large population-based birth cohort, (2) control for occupationspecific costs, macroeconomic conditions, vacancy chains and disability conditions on the estimation of productivity costs, (3) apply state-of-the-art productivity cost analyses based on adjusted productivity cost methods
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