Transferability of Productivity Loss Costs in Non-Communicable Diseases: Local Factors and Regional Adjustments
Authors:   , Rashdan Omar 
Published: January 2022

Productivity is a measure of output per unit of input (Zhang, Bansback, & Anis, 2011). In health sciences, productivity loss (PL) refers to the individual’s forgone output due to a health issue corresponding to the reduced output compared to a healthy individual. Recent years have seen considerable attention towards the adoption of a societal perspective in health economic evaluations (Brennan, Perola, van Ommen, Riboli, & Consortium, 2017). The inclusion of the societal costs into health economic evaluations can better inform policy and health decision-makers toward maximising national social welfare, even if entry costs might fall outside the annual healthcare budgets (Krol & Brouwer, 2014). Non-communicable diseases (NCDs) have been recognised to be one of the major challenges hindering countries face in their efforts to reach their sustainable development goals (SDG) (Horton, 2013). NCDs are chronic conditions requiring prolonged, expensive treatment regimens that adversely affect national revenue, socio-economic welfare, and economic growth, both directly (through medical and non-medical treatment costs) and indirectly due to productivity losses of patients as well as their carers (Bloom et al., 2012). This has been placing increasing pressure on policymakers to reimburse the most cost-effective health intervention while assuring future societal welfare. While Health Technology Assessment (HTA) generally mandates a societal perspective for informing reimbursement and resource allocation decisions, the bulk of the health economic evaluations -which are building blocks of HTA- often adopt a narrow health system perspective. Productivity loss (PL) is simply defined as the forgone output due to health issues corresponding to the reduced output compared to a healthy individual, whether paid or unpaid (Zhang et al., 2011). The inclusion of the societal costs into health economic evaluations can better inform policy and health decision-makers toward maximising national social welfare, even if entry costs might fall outside the 5 annual healthcare budgets (Krol & Brouwer, 2014). Krol and Brouwer (2014) further demonstrated that productivity loss costs can potentially be higher than the associated direct medical costs. The Middle east north Africa (MENA) region although comprising a variation in income levels, yet the region as a whole is suffering from typical LMICs symptoms of data, experts, and evidence scarcity (Ahmed M. Soliman, 2013; Al-Aqeel, 2012; Hammad, 2016). Although transferability of health economic evaluations can seem like a simple solution for the region, yet methodological diversity, non-standardisation as well as the specificities of each disease are some of the factors contributing to the complexity of the costs’ transferability across countries. We chose to work specifically with the V4 given the converging local variances in income levels, reimbursement capacity as well as the recent experience of member countries in HTA development and institutionalization. We also use HTA as a proxy for the awareness level and progression towards the adoption of a societal perspective in reimbursement decisions.