Productivity-adjusted Life Research Articles

The impact of chronic conditions on productivity-adjusted life years (PALYs) in both the workplace and household settings in the general adult population in Finland

ObjectivesThis study aimed to quantify the burden of eight non-communicable conditions on productivity-adjusted life year (PALY) at work and within the household among the Finnish general adult population. MethodsSurvey data on 18–79-year-old Finnish respondents collected in 2022 was used to calculate age- and sex-specific productivity indices at work and within the household using zero- and one-inflated beta regression for individuals with and without a certain condition (asthma or chronic obstructive pulmonary disease, cardiovascular disease, depression or other mental health problem, diabetes, gastrointestinal disease, hypothyroidism or other thyroid disease, migraine or other chronic headache, and musculoskeletal disease). Age and sex distributions of the Finnish population obtained from Statistics Finland together with the prevalence of the condition and the estimated productivity indices were used to produce the population-level one-year losses in PALYs at work and within the household. ResultsAmong eight conditions, depression and other mental health problems had the highest PALY losses (99 570 PALY loss burden at work, 256 086 PALY loss at home, and 250 980 PALY loss in general adult populations), with diabetes having the lowest (3 666 PALY loss burden at work, 46 344 PALY loss at home, and 43 443 PALY loss in general adult populations). All the examined conditions were as significant in affecting both the productivity at work and the within-household productivity. ConclusionsDepression and other mental health problems have a major effect on self-reported work ability and productivity when compared with other chronic conditions.

Quality- and productivity-adjusted life years: From QALYs to PALYs and beyond

We develop a unified framework for the measurement and valuation of health and productivity. Within this framework, we characterize evaluation functions allowing for compromises between the classical quality-adjusted life years (QALYs) and its polar productivity-adjusted life years (PALYs). Our framework and characterization results provide a new normative basis for the economic evaluation of health care interventions, as well as occupational health and safety policies, aimed to impact both health and productivity of individuals.

The Burden of Type 2 Diabetes on the Productivity and Economy in Sub-Saharan Africa: A Life Table Modelling Analysis from a South African Perspective.

The prevalence of type 2 diabetes (T2D) is rapidly increasing in Sub-Saharan Africa (SSA). T2D increases the risk of premature death and reduces quality of life and work productivity. This population life table modelling analysis evaluated the impact of T2D in terms of productivity-adjusted life years (PALYs) on the South African working-age population. Life table modelling was employed to simulate the follow-up of individuals aged 20-65 with T2D in South Africa (SA). Two life table models were developed to simulate health outcomes for a SA cohort with and without diabetes. The difference in the number of deaths, years of life lost (YLL), and PALYs lost between the two cohorts represented the burden of diabetes. Scenarios were simulated in which the proportions of gross domestic productivity (GDP), productivity indices, labour force dropout, and mortality risk trends were adjusted to lower and upper uncertainty bounds. Data were sourced from the International Diabetes Federation, Statistics SA, and both publicly available and published sources. We utilised the World Health Organization (WHO) standard annual discount rate of 3% for YLL and PALYs. In 2019, an estimated 9.5% (7.68% men and 11.37% women) or 3.2 million total working-age people had T2D in SA. Simulated follow-up until retirement predicted 669,427 excess mortality, a loss of 6.2 million years of life (9.3%) and 13 million PALYs (30.6%) in SA. On average, this resulted in 3.1 PALYs lost per person. Based on the GDP per full-time employee in 2019, the PALYs loss equated to US$223 billion, or US$69,875 per person. This study emphasises the significant impact of T2D on society and the economy. Relatively modest T2D prevention and treatment management enhancement could lead to substantial economic benefits in SA.

Modelling the burden of disease for cattle-A case of ticks and tick-borne diseases in cattle in a rural set-up in South Africa.

The study aimed to estimate the burden of ticks and tick-borne diseases (TBDs) among rural cattle-keeping households of the Eastern Cape province of South Africa using Productivity Adjusted Life Years (PALYs). We modified Disability Adjusted Life Year (DALY) equations for humans to PALYs to estimate the societal burden of tick-borne animal diseases. Whilst the World Health Organization has indicated the adaptability of DALYs to assess burden of animal diseases, nothing has been done in this regard. This could be due to several reasons including that the assessment of animal disease burden is often less of a priority compared to human diseases, particularly in low- and middle-income countries where resources may be limited. As a result, less funding and attention may be given to developing and implementing PALYs for animal diseases. Furthermore, technical and conceptual challenges may be associated with applying DALYs equations to animal diseases, such as determining appropriate measures of productivity loss for different types and categories of animals and diseases. This motivated our study, which is focused on modelling the burden of ticks and TBDs in cattle (cows, oxen and bulls) reared in resource-poor settings. We formulated a PALYs approach for cattle populations by adapting the DALYs approach to assess the burden of ticks and TBDs for cattle populations in 20 villages in the Eastern Cape province of South Africa. PALYs is a measurement used to assess the burden of disease in cattle populations, quantifying the years of life lost due to premature mortality and disability. It encompasses years of life lost due to premature mortality (YLL) and years lost due to disability (YLD) caused by health conditions. PALYs provide a comprehensive perspective on the effective number of years lost due to disability and premature death in cattle populations. The PALYs model involves several parameters that are examined to understand their impact on the model's behavior. To illustrate this, we used a structured questionnaire to collect data on parameters that feed into PALY equations. We coded and entered data from questionnaires directly into Statistical Package of Social Sciences (IBM SPSS Version 20) and entered the estimated values of PALY parameters to calculate PALYs equations, which were to estimate the societal disease burden of ticks and TBDs in cattle. PALYs calculations were done in three categories; PALYs without discounting and age weighting, PALYs with only discounting, and PALYs with discounting and age weighting in a practical example to study how these parameters influence the outcomes of the PALYs model. Our results revealed that the years of productivity lost by a cow, bull, and ox that suffered from ticks and TBDs could be estimated at various disability weights. Approximately 26%, 23% and 35% of the productivity years of a cow, ox and bull, respectively, reared by resource-poor livestock owners are lost due to the burden of ticks and TBDs in the Eastern Cape province of South Africa. However, introducing tick control measures reduces the loss to approximately 3%, 2% and 3% of their lifespan productivity, an indication that tick control will save approximately 23%, 21% and 32% of years of the productive life of cows, oxen and bulls, respectively. Therefore, it is evident that using ticks and TBD prevention measures at an early age of cattle will improve cattle productivity and hence the socioeconomic welfare of resource-poor rural farming communities in the Eastern Cape province of South Africa. The findings generated from the PALYs approach are helpful in projections for the future burden of any livestock disease. They may be used as a basis in policy formulation and decision-making by various stakeholders, and hence a priority in animal health economics. We recommend that a classification of livestock diseases of national economic importance should consider both the societal burden (non-monetary) and economic impact instead of the common practice of only considering the economic (monetary) impact. Adding a societal burden measure to existing economic measures provides a holistic understanding of the impact of a disease on society especially in resource-limited settings where the livestock value goes beyond monetary value.

Non-optimum temperatures and productivity-adjusted life years lost in Brazil: a nationwide time-series study

Non-optimum temperatures and productivity-adjusted life years lost in Brazil: a nationwide time-series study

Productivity-adjusted life years lost due to non-optimum temperatures in Brazil: A nationwide time-series study

Non-optimal temperatures are associated with premature deaths globally. However, the evidence is limited in low- and middle-income countries, and the productivity losses due to non-optimal temperatures have not been quantified. We aimed to estimate the work-related impacts and economic losses attributable to non-optimal temperatures in Brazil. We collected daily mortality data from 510 immediate regions in Brazil during 2000 and 2019. A two-stage time-series analysis was applied to evaluate the association between non-optimum temperatures and the Productivity-Adjusted Life-Years (PALYs) lost. The temperature-PALYs association was fitted for each location in the first stage and then we applied meta-analyses to obtain the national estimations. The attributable fraction (AF) of PALY lost due to ambient temperatures and the corresponding economic costs were calculated for different subgroups of the working-age population. A total of 3,629,661 of PALYs lost were attributed to non-optimal temperatures during 2000–2019 in Brazil, corresponding to 2.90 % (95 % CI: 1.82 %, 3.95 %) of the total PALYs lost. Non-optimal temperatures have led to US$104.86 billion (95 % CI: 65.95, 142.70) of economic costs related to PALYs lost and the economic burden was more substantial in males and the population aged 15–44 years. Higher risks of extreme cold temperatures were observed in the South region in Brazil while extreme hot temperatures were observed in the Central West and Northeast regions. In conclusion, non-optimal temperatures are associated with considerable labour losses as well as economic costs in Brazil. Tailored policies and adaptation strategies should be proposed to mitigate the impacts of non-optimal temperatures on the labour supply in a changing climate.

Estimating the impact of Angelman syndrome on parental productivity in Australia using productivity-adjusted life years

BackgroundAngelman syndrome (AS) is a rare genetic condition characterized by global developmental delay, including severe intellectual disability. The parents of persons with AS experience increased stress, anxiety, and depression. This impacts parents’ career choices and productivity. ObjectiveTo estimate, for the first time, the total productivity lost by the parents of persons with AS over a 10-year period in Australia and the corresponding cost to society. MethodsA cost-of-illness model with simulated follow-up over a 10-year period was developed, with 2019 as the baseline year, facilitated by a Markov chain of life tables. The prevalence of persons with AS and their parents, the productivity-adjusted life years (PALYs) lost by parents, and the cost to society were estimated. Key data were obtained from a prospective cohort of AS families, peer-reviewed literature, and publicly available sources. ResultsThe base-case productivity burden borne by the estimated 330 living parents of the 428 prevalent persons with AS totaled AUD$45.30 million, corresponding to a loss of 38.42% of PALYs per parent. ConclusionsCaring for a child with AS has a significant impact on the productivity of affected parents, with a large associated impact on the broader Australian economy.

Potential productivity loss from uncorrected and under-corrected presbyopia in low- and middle-income countries: A life table modeling study.

ObjectiveTo estimate the burden of potential productivity losses due to uncorrected and under-corrected presbyopia in LMICs among the working-age population in both the cross-sectional and longitudinal manner.MethodsWe extracted data for the prevalence of presbyopia from the Global Burden of Diseases (GBD), Injuries, and Risk Factors Study 2019. Data for the gross domestic product (GDP) per capita were extracted from the World Bank database and Central Intelligence Agency's World Factbook. We introduced life table models to construct age cohorts (in 5-year age groups) of the working-age population (aged from 40 to 64 years old) in LMICs, with simulated follow-up until 65 years old in people with and without uncorrected presbyopia. The differences in productivity-adjusted life years (PALYs) lived and productivity between these two cohorts were calculated. The potential productivity loss was estimated based on GDP per capita. The WHO standard 3% annual discount rate was applied to all years of life and PALYs lived.ResultsIn 2019, there were 238.40 million (95% confidence interval [CI]: 150.92–346.78 million) uncorrected and under-corrected presbyopia cases in LMICs, resulting in 54.13 billion (current US dollars) (95% confidence interval [CI]: 34.34–79.02 billion) potential productivity losses. With simulated follow-up until retirement, those with uncorrected and under-corrected presbyopia were predicted to experience an additional loss of 155 million PALYs (an average loss of 0.7 PALYs per case), which was equivalent to a total loss of US$ 315 billion (an average loss of US$ 1453.72 per person).ConclusionsOur findings highlight the considerable productivity losses due to uncorrected and under-corrected presbyopia in LMICs, especially in a longitudinal manner. There is a great need for the development of enabling eye care policies and programs to create access to eye care services, and more healthcare investment in the correction of presbyopia in the working-age population in LMICs. This study could provide evidences for some potential health-related strategies for socio-economic development.

Estimating the benefits of obesity prevention on productivity: an Australian perspective

Background/objectivesObesity poses one of the biggest public health challenges globally. In addition to the high costs of obesity to the healthcare system, obesity also impacts work productivity. We aimed to estimate the benefits of preventing obesity in terms of years of life, productivity-adjusted life years (PALYs) and associated costs over 10 years.Subjects/methodsDynamic life table models were constructed to estimate years of life and PALYs saved if all new cases of obesity were prevented among Australians aged 20–69 years from 2021 to 2030. Life tables were sex specific and the population was classified into normal weight, overweight and obese. The model simulation was first undertaken assuming currently observed age-specific incidences of obesity, and then repeated assuming all new cases of obesity were reduced by 2 and 5%. The differences in outcomes (years of life, PALYs, and costs) between the two modelled outputs reflected the potential benefits that could be achieved through obesity prevention. All outcomes were discounted by 5% per annum.ResultsOver the next 10 years, 132 million years of life and 81 million PALYs would be lived by Australians aged 20–69 years, contributing AU$17.0 trillion to the Australian economy in terms of GDP. A 5% reduction in new cases of obesity led to a gain of 663 years of life and 1229 PALYs, equivalent to AU$262 million in GDP.ConclusionsPrevention of obesity is projected to result in substantial economic gains due to improved health and productivity. This further emphasises the need for public health prevention strategies to reduce this growing epidemic.

Modeling the non-monetary societal burden of Tick-borne diseases for cattle: A case study of East Coast Fever in the traditional cattle-keeping households of Namwala District of Zambia

The study aimed to estimate the disease burden of East Coast fever (ECF) among rural cattle-keeping households of Namwala District of Zambia using Productivity Adjusted Life Years(PALYs). We modified Disability Adjusted Life Year (DALY) equations for humans to PALYs to estimate the societal burden of tick-borne animal diseases. We used a structured questionnaire to collect data on parameters that feed into PALY equations. We coded and entered data from questionnaires directly into Statistical Package of Social Sciences (IBM SPSS Version 20) and entered the estimated values of PALY parameters into Mathematical Calculus Software called integral calculator (https://www.integral-calculator.com/). We then used the integral calculator to calculate PALY equations, which we used to estimate the societal disease burden of ECF in cattle. PALYs calculations were done in three categories; PALYs without discounting and age weighting, PALYs with only discounting, and PALYs with discounting and age weighting. Results revealed that the years of productivity lost by a cow, bull, and ox that suffered from ECF were estimated at 15, 10, and 15 years, respectively. In the second category, the years of productivity lost by a cow, bull, and ox were seven, six, and seven years, respectively. In the final category, the years of productivity lost by a cow, bull, and ox were five years. ECF caused a total of 517,165 PALYs in Namwala District. The quality of life reduced in years due to disability (YLD) caused by ECF per cow, bull, and ox was 0.07, 0.07, and 0.02 percent of their life expectancy, respectively. The estimated values for the years of a lifetime lost due to mortality (YLL) caused by ECF were 35%, 49%, and 35% of the life expectancy per cow, bull, and ox. These results are essential for measuring outcomes of animal health problems in terms of PALYs. The findings are helpful in future projections for the future burden of any disease and can be used as a basis in policy-making and decision-making, particularly priorities in animal health research. We recommend that a classification of animal diseases of national economic importance should consider both the societal burden (non-monetary) and economic impact instead of the common practice of only considering the economic (monetary) impact.

The Impact of Diabetes on Productivity in India

Diabetes increases the risk of premature mortality and considerably impacts on work productivity. We sought to examine the impact of diabetes in India, in terms of excess premature mortality, years of life lost (YLL), productivity-adjusted life years (PALYs) lost, and its associated economic impact. A life table model was constructed to examine the productivity of the Indian working-age population currently aged 20-59 years with diabetes, followed until death or retirement age (60 years). The same cohort was resimulated, hypothetically assuming that they did not have diabetes. The total difference between the two cohorts, in terms of excess deaths, YLL and PALYs lost reflected the impact of diabetes. Data regarding the prevalence of diabetes, mortality, labor force dropouts, and productivity loss attributable to diabetes were derived from published sources. In 2017, an estimated 54.4 million (7.6%) people of working-age in India had diabetes. With simulated follow-up until death or retirement age, diabetes was predicted to cause 8.5 million excess deaths (62.7% of all deaths), 42.7 million YLL (7.4% of total estimated years of life lived), and 89.0 million PALYs lost (23.3% of total estimated PALYs), equating to an estimated Indian rupee 176.6 trillion (U.S. dollars 2.6 trillion; purchasing power parity 9.8 trillion) in lost gross domestic product. Our study demonstrates the impact of diabetes on productivity loss and highlights the importance of health strategies aimed at the prevention of diabetes.

Modelling the Societal Burden of Anthrax in Cattle in the Western Province of Zambia Using a Modification of Disability Adjusted Life Years

Anthrax, which is a naturally occurring zoonotic disease caused by the bacterium Bacillus anthracis, has been endemic in Western Zambia. This paper estimated the societal burden of anthrax on cattle using Productivity Adjusted Life Years (PALYs) among cattle farmers in the Western Province of Zambia. A quantitative cross-sectional study design was used to collect data from cattle farmers in Mongu, Nalolo and Limulunga districts of Western Zambia. The Disability-Adjusted Life Years (DALY) model for human populations was modified and adapted to the animal population model, PALYs, to estimate the societal burden of animal diseases. The integral calculator was used to estimate the societal disease burden of anthrax using PALY equations in three categories: PALYs without discounting and age weighting, PALYs with only discounting, and PALYs with discounting and age weighting. The results showed that anthrax affected the quality of life years lived by animals significantly due to years lost due to disability (YLD) and years lost due to premature death (YLL). A cow, bull and ox lost about 34%, 39% and 37% of productivity years of its life span due to anthrax. This shows that a bull lost most years of productivity, seconded by an ox and, lastly, a cow. Anthrax further caused a total loss of 459,280.90 PALYs in the three districts. The quality of life is improved, and productivity losses are reduced to almost 0% for all three types of animals by introducing effective anthrax control measures in the absence of other adverse health conditions. Anthrax negatively affected livestock production due to significant loss of healthy years of life and loss of quality of life. Since bulls lost most of the productivity years of their life span, we argue that transportation, draught power, sells as well, as socio status were the most affected as these are usually performed by the bull, the most productive. Therefore, it is important to minimise the loss of cattle productivity through morbidity and mortality. Different intervention programmes for the same disease can be compared in cost-effective analysis using PALYs as one of the tools. Therefore, the societal burden of diseases should also be applied on top of other existing methods used to assess the impact of diseases on animals to enable policymakers to have a complete and comprehensive picture of the impact.

Productivity burden of hypertension in Japan.

In the present study, we aimed to estimate the impact of hypertension in the working-age Japanese population. We developed life table models to estimate total deaths, years of life lived, and productivity-adjusted life years lived (a newly developed metric for quantifying the burden of acute and chronic health conditions on work productivity) among Japanese individuals with hypertension aged 20-64 years, with simulated follow-up until age 65 years. Data inputs were drawn from local population statistics and published sources. Gross domestic product per person employed, a measure of labor productivity, was used to assign an economic value to each productivity-adjusted life year lived. Outcomes and costs were discounted by 2% annually. In 2017, 26.3 million Japanese individuals aged 20-64 years (37.5%) had hypertension. Of these people, 23.7% were treated and had controlled blood pressure, 23.2% were treated but had uncontrolled blood pressure, and 53.1% were untreated. During the simulated follow-up until age 65 years, 335,342 deaths (28.0% of total deaths), 1.6 million years of life (0.8% of total), 3.1 million productivity-adjusted life years (1.9% of total), and US$242.9 billion or 28.3 trillion Japanese yen of gross domestic product were lost to hypertension. Our findings highlight the considerable economic burden of hypertension in Japan, as well as the importance of effective strategies for hypertension prevention and management, which are likely to deliver a significant return on investment.

Estimating the Productivity Impact of Acute Myeloid Leukemia in Australia Between 2020 and 2029, Using a Novel Work Utility Measure: The Productivity-Adjusted Life Year (PALY).

Acute myeloid leukemia (AML) is a rare hematologic malignancy accounting for 0.8% of new cancer diagnoses in Australia. High mortality and morbidity affect work productivity through workforce dropout and premature death. This study sought to estimate the productivity loss attributable to AML in the Australian population over 10 years and to estimate the costs of this productivity loss. Productivity was measured using productivity-adjusted life years (PALYs), a similar concept to quality-adjusted life years, but adjusts for the productivity loss attributable to disease, rather than impaired health. Dynamic life tables modeled the Australian working population (age 15-65 years) between 2020 and 2029. The model population had two cohorts: those with and without AML. Differences in life years, PALYs, and costs represented the health and productivity impact of AML. Secondary analyses evaluated the impact of different scenarios. Over the next 10 years, there will be 7,600 years of life lost and 7,337 PALYs lost because of AML, amounting to Australian dollars (AU$) 1.43 billion in lost gross domestic product ($971 million in US dollars). Secondary analyses highlight potential savings of approximately AU$52 million if survival rates were improved by 20% and almost AU$118 million in savings if the return-to-work rates increased by 20% on the current estimates. Our study demonstrates that even in low-incidence cancer, high mortality and morbidity translate to profound impacts on years of life, productivity, and the broader economy. Better treatment strategies are likely to result in significant economic gains. This highlights the value of investing in research for improved therapies.

The economic impact of sudden cardiac arrest

BackgroundThere are 20,000 sudden cardiac arrests (SCAs) in Australia annually, with 90% case-fatality. ObjectiveThe present study calculated both the health and economic impact of SCAs in Victoria, Australia. MethodsData on all SCAs attended by Ambulance Victoria from July 2017 to June 2018 were collected regarding age, gender, and survival to hospital, discharge and 12 months. Pre-SCA employment status of all patients was modelled using age and gender-matched Australian economic data. A Markov state-transition model with a five-year horizon calculated health and economic impact in years of life lived (YLL), productivity-adjusted life years (PALYs) and gross domestic product (GDP) lost. A counterfactual Markov state-transition model assessed outcomes of an identical cohort of patients who did not experience SCA. All values were discounted by 5%. ResultsIn 12 months, 4637 people suffered SCAs in Victoria, of whom 1516 (32.7%) were working at the time. 695 patients (15.0%) survived to hospital, 325 (7.0%) to discharge, and 303 (6.5%) to 12 months. In five years following their SCA, the cohort lost 15,922 years of life and 2327 PALYs. Reduced productivity led to GDP losses of AUD$448 million (92.8% relative reduction). Extrapolated to the 20,000 SCAs occurring across all of Australia, total GDP losses approached AUD$2 billion. ConclusionThe health and economic burden of SCAs is high, predominantly underpinned by very high mortality. Annual national losses approach AUD$2 billion (USD$1.42 billion) and are comparable to productivity losses from all cancers combined. Prioritising research and state-of-the-art care for SCA patients appears economically sound.

The Preventable Productivity Burden of Kidney Disease in Australia.

Kidney disease is associated with impaired work productivity. However, the collective effect of missed work days, reduced output at work, and early withdrawal from the workforce is rarely considered in health-economic evaluations. To determine the effect on work productivity of preventing incident cases of kidney disease, using the novel measure "productivity-adjusted life year" (PALY), we constructed a dynamic life table model for the Australian working-age population (aged 15-69 years) over 10 years (2020-2029), stratified by kidney-disease status. Input data, including productivity estimates, were sourced from the literature. We ascribed a financial value to the PALY metric in terms of gross domestic product (GDP) per equivalent full-time worker and assessed the total number of years lived, total PALYs, and broader economic costs (GDP per PALY). We repeated the model simulation, assuming a reduced kidney-disease incidence; the differences reflected the effects of preventing new kidney-disease cases. Outcomes were discounted by 5% annually. Our projections indicate that, from 2020 to 2029, the estimated number of new kidney-disease cases will exceed 161,000. Preventing 10% of new cases of kidney disease during this period would result in >300 premature deaths averted and approximately 550 years of life and 7600 PALYs saved-equivalent to a savings of US$1.1 billion in GDP or US$67,000 per new case avoided. Pursuing a relatively modest target for preventing kidney disease in Australia may prolong years of life lived and increase productive life years, resulting in substantial economic benefit. Our findings highlight the need for investment in preventive measures to reduce future cases of kidney disease.

Productivity-adjusted life years lost due to type 2 diabetes in Germany in 2020 and 2040

Aims/hypothesisType 2 diabetes can lead to reduced productivity during working age. We aimed to estimate productive life years lost associated with type 2 diabetes on the individual and population level in Germany in 2020 and 2040, while accounting for future trends in mortality.MethodsBased on a mathematical projection model, we estimated age- and sex-specific productivity losses associated with type 2 diabetes during working age (20–69 years) in Germany in 2020 and 2040. Productivity losses in terms of excess mortality (years of life lost, YLL) and reductions in labour force participation, presenteeism and absenteeism (years of productivity lost, YPL) were summed to calculate productivity-adjusted life years (PALY) lost. Input data for the projection were based on meta-analyses, representative population-based studies and population projections to account for future trends in mortality.ResultsCompared with a person without type 2 diabetes, mean PALY lost per person with type 2 diabetes in 2020 was 2.6 years (95% CI 2.3, 3.0). Of these 2.6 years, 0.4 (95% CI 0.3, 0.4) years were lost due to YLL and 2.3 (95% CI 1.9, 2.6) years were lost due to YPL. Age- and sex-specific results show that younger age groups and women are expected to lose more productive life years than older age groups and men. Population-wide estimates suggest that 4.60 (95% CI 4.58, 4.63) million people with prevalent type 2 diabetes in 2020 are expected to lose 12.06 (95% CI 10.42, 13.76) million PALY (1.62 million years due to YLL and 10.44 million years due to YPL). In 2040, individual-level PALY lost are projected to slightly decrease due to reductions in YLL. In contrast, population-wide PALY lost are projected to increase to 15.39 (95% CI 13.19, 17.64) million due to an increase in the number of people with type 2 diabetes to 5.45 (95% CI 5.41, 5.50) million.Conclusions/interpretationOn the population level, a substantial increase in productivity burden associated with type 2 diabetes was projected for Germany between 2020 and 2040. Efforts to reduce the incidence rate of type 2 diabetes and diabetes-related complications may attenuate this increase.Graphical abstract

Burden of disease and productivity impact of Streptococcus suis infection in Thailand

Streptoccocus suis (S.suis) infection is a neglected zoonosis disease in humans mainly affects men of working age. We estimated the health and economic burden of S.suis infection in Thailand in terms of years of life lost, quality-adjusted life years (QALYs) lost, and productivity-adjusted life years (PALYs) lost which is a novel measure that adjusts years of life lived for productivity loss attributable to disease. A decision-analytic Markov model was developed to simulate the impact of S. suis infection and its major complications: death, meningitis and infective endocarditis among Thai people in 2019 with starting age of 51 years. Transition probabilities, and inputs pertaining to costs, utilities and productivity impairment associated with long-term complications were derived from published sources. A lifetime time horizon with follow-up until death or age 100 years was adopted. The simulation was repeated assuming that the cohort had not been infected with S.suis. The differences between the two set of model outputs in years of life, QALYs, and PALYs lived reflected the impact of S.suis infection. An annual discount rate of 3% was applied to both costs and outcomes. One-way sensitivity analyses and Monte Carlo simulation modeling technique using 10,000 iterations were performed to assess the impact of uncertainty in the model. This cohort incurred 769 (95% uncertainty interval [UI]: 695 to 841) years of life lost (14% of predicted years of life lived if infection had not occurred), 826 (95% UI: 588 to 1,098) QALYs lost (21%) and 793 (95%UI: 717 to 867) PALYs (15%) lost. These equated to an average of 2.46 years of life, 2.64 QALYs and 2.54 PALYs lost per person. The loss in PALYs was associated with a loss of 346 (95% UI: 240 to 461) million Thai baht (US$11.3 million) in GDP, which equated to 1.1 million Thai baht (US$ 36,033) lost per person. S.suis infection imposes a significant economic burden both in terms of health and productivity. Further research to investigate the effectiveness of public health awareness programs and disease control interventions should be mandated to provide a clearer picture for decision making in public health strategies and resource allocations.

The impact of coronary heart disease on productivity in Australia over ten years

Abstract Background Coronary heart disease (CHD) is the highest individual disease burden in Australia and associated with productivity losses through unplanned absence from work, reduced output while at work and early labour force withdrawal. Approximately eighty per cent of CHD cases in Australia are preventable, suggesting the potential benefit of employing preventive strategies addressing populations at risk of CHD. Purpose To determine the preventable productivity burden attributable to CHD over the next ten years, using the novel productivity measure: the “productivity-adjusted life year” (PALY). Methods A dynamic life table model was constructed for the total Australian population, separated by CHD status. Analysis was limited to the Australian working-age population (15–69 years) over ten years (2020–2029). Australian age- and sex-specific prevalence, incidence, migration and mortality data was employed, and productivity estimates were sourced from the literature. The PALY was ascribed a financial value in terms of gross domestic product (GDP) per equivalent full-time worker. The total number of years lived, total PALYs, and total economic burden (in terms of cost of PALYs) were estimated for each year. The model simulation was repeated assuming incidence was reduced, and the differences represented the preventable productivity burden attributable to CHD. All outcomes beyond the first year were discounted by 5% per annum. Results Over the next ten years, the total projected years lived and PALYs among the Australian working-age population (with and without CHD) were approximately 132 million and 83 million, respectively, amounting to A$17.2 trillion (€10.5 trillion) in GDP. We predicted nearly 40,000 new (incident) CHD cases over this ten-year period. If, however, we could prevent these new cases of CHD, a total of 14,000 deaths could be averted, resulting in more than 8,000 years of life saved and 100,000 PALYs gained, equivalent to A$21 billion (€12.9 billion) in GDP. Conclusion Prevention of CHD will prolong both years of life lived and productive life years, resulting in substantial economic benefit. Policy makers and employers are encouraged to engage in preventive measures addressing CHD. Funding Acknowledgement Type of funding source: None

Assessing the impact of smoking on the health and productivity of the working-age Indonesian population using modelling

ObjectivesTo estimate the impact of smoking in the working-age Indonesian population in terms of costs, years of life, quality-adjusted life years (QALYs) and productivity-adjusted life years (PALYs) lost.MethodsLife table modelling...