Today (18 June) in Seoul, South Korea, I presented some of our Fit for Work research at the annual conference of Health Technology Assessment International (HTAi) – one of the largest gatherings of health economists in the world; the presentations of which are available to download. Our session had the title:
How Health Technology Assessments can consider Labour Market Participation and Work Productivity as a Clinical Outcome: Comparative case studies of international practice.
The number of individuals of working age living with at least one chronic condition is increasing due to the effects of population ageing, poor lifestyle choices and later retirement. Most individuals with long-term conditions want to work, but many are denied this opportunity because some employers and healthcare professionals fail to recognise that being in good quality work can aid condition management and rehabilitation, ultimately reducing the economic burden on the state, employers and households. Yet, in many countries the HTA regimes do not take into account labour market outcomes when assessing the cost-effectiveness of interventions.
During the last year, the Fit for Work Europe Coalition has brought together experts from across the globe to explore evidence for the inclusion of a wider societal perspective in healthcare decision-making. Despite methodological issues, evidence suggests that macro cross-governmental decisions between healthcare, labour, and welfare departments could apply HTA as a way of counteracting the effects of ageing and rise in disability on labour market participation and work productivity. Our eight case studies found that the scope of HTA agencies, and the incentives to adopt the results of HTA differ between countries, which limits the ability of HTA to consider a wide range of investments (such as new treatments and devices), as well as the implementation of recommendations informed by HTA. The panel compared the use of societal and payer perspectives in health decision-making internationally, and provided practical recommendations for health economists and policymakers.
The session was chaired by Dr Chris Henshall an associate professor of the health economics research group at Brunel University and visiting fellow at the centre for health economics at the University of York. As well as myself, we were joined by Dr Marieke Krol of the institute for medical technology assessment at the Erasmus University in the Netherlands and Dr Rupendra Shrestra who is a research fellow of the NHMRC clinical trials centre at the Sydney Medical School at The University of Sydney in Australia.
The consensus of the presentations and the panel discussion was that work productivity data could enhance healthcare decision-making in many cases, especially where people of working age ran a high risk of leaving the labour market as a result of their health. Dr Shrestra presented data from Australia which showed that 58% of men between the ages of 45-64 years who leave the labour market, do so because of a health condition. Dr Krol suggested that, from her analysis, if work productivity were included routinely in health economic assessments of medical interventions, approximately 30% of decisions to deny access on cost-utility grounds would be overturned.
The panel agreed that, while more work was needed to reach consensus on the methods used to calculate productivity costs, the demographic shifts in the workforce and the need to extend healthy working lives provided compelling impetus for more proactive use of healthcare interventions to help more people with chronic conditions to remain in, or return to, work.