PharmacoEconomics & Outcomes News 323 - 28 Jul 2001

a regulator) and academia – should see enough potentialProductivity – looking beyond costpayoffs to become interested in the productivityeffectiveness movement also, said Dr Ozminkowski. Thus, ‘win-winsituations’ in which all parties benefit need to be lookedThe strategic value of the concept of productivity as itat, he said.may pertain to clinical trials, cost-of-illness studies and

postmarketing research was the theme of a contributed The metrics of productivityworkshop on economic methodology held at this year’s Productivity is usually considered in negative terms,6th annual ISPOR meeting [Arlington, Virginia, US; May explained Dr Ozminkowski. For example, absenteeism,2001]. The director of Outcomes, Research and disability programme use and workers’ compensationEconometrics of the MEDSTAT Group, Inc., US, Dr programme use are typical measures of what employeesRonald Ozminkowski, argued on behalf of his associates cannot do. On the other hand, for employees still atthat a greater consideration of outcomes, including work, the drop in productivity due to health problems isproductivity-related outcomes, would help to better often referred to as presenteeism; outside ofserve the multiple stakeholders in healthcare in the US.1 manufacturing environments, this can be hard to

Productivity is hard to define, commented Dr measure, particularly in team-oriented and knowledge-Ozminkowski. From the perspective of business based environments, he said. For example, employeeseconomics, productivity refers to the level of output that sometimes take work home with them, or they will frontis produced for every unit of input, where inputs include up for work but achieve very little. How can this loss inpeople, computers, machinery, supplies, and so on. productivity be accurately measured?Enhancing researchers’ interest in productivity as an A number of efforts have been made to measureoutcome in clinical trials, cost-of-illness and presenteeism in the work place, including use of thepostmarketing studies ‘can be a good thing’, he said. Work Limitation Questionnaire, the Health and LaborHowever, he cautioned that the underlying research Questionnaire, the Work Productivity and Impairmentneeds to be conducted correctly if enhancing patients’ Questionnaire, and the Endicott Work Productivityproductivity is to benefit everyone involved. A focus on Scale. All of these instruments have some evidence ofpeople is needed, and there needs to be a move away validity for measuring presenteeism. Still being tested isfrom viewing machinery as the primary part of the the Stanford Presenteeism Scale. Most of theseequation that drives productivity. measures can be completed by the employee in ≤ 10

minutes and are ‘relatively easy’ to complete, said DrThe interested partiesOzminkowski. They take a broad view of employees’Although incomplete, the following list includesperformance at work, instead of merely focusing onparties that would have an interest in productivity.absenteeism.• Patients: there is a ‘sense of worth’ linked with being

productive, said Dr Ozminkowski; therefore, if Adding productivity completes the puzzle?patients get back to work faster, they can Part of the challenge in measuring productivity, saidaccomplish more. Dr Ozminkowski, is in counting it; should it be counted

• Caregivers: this includes those taking care of in days missed from work or in monetary units?someone with a chronic condition, such as asthma Nonlabour units, such as machinery, need to be takenor Alzheimer’s disease; enhancing caregivers’ into account when calculations are made in terms ofproductivity means that they would be able to get monetary units, he said. Above all, the productivityback to work, or resume other activities, faster. metrics need to be ‘sound’, and they need to be applied

• Physicians: they often do more than just treat in a scientifically credible way, he added. Traditionally,patients’ symptoms; they would do a better job of productivity loss has been correlated with the typicaltreating the whole patient if they included quality-of-life (QOL) measures in cost-effectiveness andproductivity as an outcome of treatment. cost-utility analyses. However, although quality-

• Health plans: they would be better able to meet the adjusted life-years (QALYs) are valuable, they do notexpectations of patients and healthcare payers if capture all the relevant outcomes, includingincreased productivity was a measured goal of care. productivity. While QOL, morbidity, mortality and

As well as those listed above, payers would have an medical costs are usually looked at separately, Drinterest in productivity; such knowledge would mean Ozminkowski argued that adding productivity to the mixthey could serve their patients and clients more would lead to better answers to the research question,effectively. Regulators with an interest in productivity reductions in caregiver burden, improved therapies,would be better equipped for making public-health healthier and better functioning patients, and betterpolicy decisions. Pharmaceutical companies, too, would public policy.be able to use productivity as an argument for payers;

Some early examplesthey would be able to demonstrate the effectiveness ofResearch involving productivity metrics has tried totheir products using a more complete set of outcomes,

account for productivity-related outcomes in theincluding productivity.treatment of several disorders. A Medline search of theIndeed, the search for information about productivityliterature found the following examples.at present appears to be driven by pharmaceutical• Anxiety: a 1999 study found that anxiety disorderscompanies. In the US, employers foot the bill for the

such as post-traumatic stress disorder and panicmajority of healthcare for those aged < 65 years, noteddisorder cost an estimated $US42.3 billion in totalDr Ozminkowski. Thus, employers have some influencecosts in 1990, of which 54% was attributed toas major purchasers of drugs. As such, pharmaceuticalmedical costs and 10% was attributed to workplacecompanies have come to view employers as potentialcosts.clients. Based on what employers are achieving, other

• Asthma: a study conducted earlier this year foundparties – including consumer groups, patient-advocacythat productivity may be enhanced through diseasegroups, the federal government (as a sponsor, not just as

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management programmes that help patients usebetter medications.

• Depression: compared with employees withoutdepression, those with depression had an additional1.5–3.2 short-term work disability days over a30-day period in 1999; however, the researchersfound that the cost of treating depression was aboutthe same as the value of lost productivity. Another1999 study found that absenteeism in depressedemployees was reduced when the depression wastreated, while a study conducted 1 year earliershowed that treating depression enhanced workperformance, with the majority of improvementtaking place in the first 4 weeks of therapy.

• Migraine: research in 1999 showed thatproductivity-related costs of migraine wereconsiderable, while an analysis conducted in 2000found that productivity loss at work could bereduced with treatment.

The strategic value of productivity is a fairly newconcept, and more good studies that involveproductivity metrics are needed, according to DrOzminkowski. However, a change in attitude is needed;productivity is often ignored because of the difficulty inmeasuring it. These early findings suggest thatpharmaceutical companies, employers, health plans andother sponsors may become interested enough tocommit the money and time needed to develop a focuson productivity – doing so should benefit all the majorplayers in healthcare in the long run.1. Ozminkowski RJ, et al. Beyond cost-effectiveness: the strategic value of

productivity-related outcomes in clinical trials, burden of illness studies, andpost-marketing research. Value in Health 4: 191 (plus oral presentation), Mar-Apr 2001.

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