Productivity loss and productivity loss costs to United States employers due to priority conditions: a systematic review

PLAIN LANGUAGE SUMMARY Investment in workforce health and well-being is a practice pursued by high-performing companies as health improvement strategies have produced excellent returns on investment. This literature review sought to gain a better understanding of employee productivity loss for important diseases (i.e. cancer, chronic lung disease [bronchitis, asthma, or chronic obstructive pulmonary disease], depression, pain, and cardiometabolic disease [heart disease, hypertension, or diabetes] to help employers and healthcare payers prioritize investment in workforce health. The findings highlight the substantial burden of lost productivity among these conditions. Most studies found employees lost up to 80 annual work hours and employees with cancer and cardiometabolic disease had the greatest annual incremental number of work hours lost. The proportion of work impairment ranged from 10% to 70% and was higher for employees with pain and depression. The annual cost of lost work productivity ranged from $100 to $10,000 and was higher among employees with cancer, pain, and depression. Aims To summarize published studies evaluating productivity loss and productivity loss costs associated with cancer, chronic lung disease, depression, pain, and cardiometabolic disease among US employees. Materials and methods A PubMed search from the past 10 years was conducted using the terms productivity, absenteeism, presenteeism, cancer, bronchitis, asthma, chronic obstructive pulmonary disease, depression, pain, heart disease, hypertension, and diabetes (limited to English-language publications and studies of adults aged 19-64). Study endpoints included annual incremental time (work hours lost and Work Productivity and Impairment [WPAI] questionnaire overall work impairment) and monetary estimates of productivity loss. Studies were critically appraised using a modified Oxford Centre for Evidence-Based Medicine (OCEBM) Quality Rating Scheme. Results Of 2,037 records identified from the search, 183 studies were included. The most common observed condition leading to productivity loss was pain (24%), followed by cancer (22%), chronic lung disease (17%), cardiometabolic disease (16%), and depression (16%). Nearly three-quarters of the studies (n = 133, 72.7%) were case-control/retrospective cohort studies (OCEBM quality rating 3); the remainder were case series/cross-sectional studies (n = 28, 15.3%; quality rating 4), randomized clinical trials (n = 18, 9.8%; quality rating 1); and controlled trials without randomization/prospective comparative cohort trials (n = 4, 2.2%; quality rating 2). Samples sizes ranged from 18 patients to millions of patients for studies using the Medical Expenditure Panel Survey (MEPS). Most studies found employees lost up to 80 annual incremental work hours; employees with cancer and cardiometabolic disease had the greatest number of work hours lost. Overall percentage work impairment ranged from 10% to 70% and was higher for pain and depression. Annual incremental costs of lost work productivity ranged from $100 to $10,000 and were higher for cancer, pain, and depression. Limitations Study heterogeneity. Conclusions Despite some gaps in evidence for the cost of productivity loss, sufficient data highlight the substantial employer burden of lost productivity among priority conditions.