Advancing Lost Productivity Measurement in Economic Evaluations: Evidence Priorities from a Targeted Literature Review and Expert Workshop.

BACKGROUND: Productivity losses from illness, treatment, and informal caregiving impose a substantial economic burden on patients, caregivers, employers, and society in the United States (US), but measurement remains inconsistent and often omits key domains, such as presenteeism and unpaid non-market work productivity. These gaps limit the integration of productivity into economic evaluations and policy and may lead to undervaluation of interventions that improve health and reduce disease burden. OBJECTIVE: The aim was to identify evidence priorities and methodological improvements for measuring and valuing productivity in US economic evaluations. METHODS: A targeted literature review (TLR) of US-based studies published from 2020 to 2024 was conducted to evaluate measurement of absenteeism, presenteeism, or unpaid non-market work productivity. Definitions, instruments, valuation methods, and reporting practices were extracted. Findings informed a virtual workshop with eight stakeholders, who completed prioritization exercises and participated in facilitated discussions to refine evidence priorities and methodological recommendations. RESULTS: Thirty studies met the TLR inclusion criteria. Absenteeism was assessed in 77%, unpaid non-market work productivity in 67%, and presenteeism in 37%. The Work Productivity and Activity Impairment questionnaire was used in 40%. Only 30% assessed informal caregiving-related productivity losses, 23% included fringe benefits, and 37% used longitudinal designs. In the workshop, stakeholders prioritized four predefined domains for future evidence generation and value assessment: (1) measuring longitudinal fluctuations in productivity by disease severity; (2) valuing unpaid non-market work productivity; (3) measuring presenteeism; and (4) disaggregating productivity by job types and wfork environments. Recommendations included transparent, perspective-specific valuation; capturing total compensation in absenteeism costs; disaggregating time-based and monetary outcomes; and developing instruments suitable for remote, hybrid, and gig work. CONCLUSIONS: Productivity losses are an underrecognized component of disease burden in the US. More consistent use of validated instruments, particularly for measuring longitudinal and unpaid non-market work productivity, may improve the reliability and policy relevance of productivity estimates.