A review of methods to measure health-related productivity loss.

BACKGROUND Annual US health-related productivity losses are estimated to reach some $260 billion, attributable not only to absenteeism but also to presenteeism (being present at work but working at a reduced capacity). The search for remedies has been hampered by the lack of accurate estimates of the loss of productivity and its true costs. To date, little effort has been made to assess the availability of measurement instruments or the validity and reliability of those that exist. OBJECTIVES To systematically review the instruments used to measure productivity loss and its costs and to assess limitations in current research. DESIGN A systematic search was conducted of the published and gray-market research literature from 1995 through 2005 on methods for estimating productivity loss and monetizing that loss. RESULTS Twenty survey instruments were identified that assess the effect of health problems on absenteeism or presenteeism by attempting to quantify self-perceived or comparative impairment or by measuring unproductive work time. Some of the methods have been validated. The challenges of measuring presenteeism far exceed those of measuring absenteeism primarily because many jobs do not have easily measurable output. Methods to estimate the cost of lost productivity were also identified; however, none have been validated, to our knowledge. CONCLUSIONS The greatest impediment to estimating the cost of productivity lost to illness is the lack of established and validated methods for monetization. The issues raised in this review are intended to stimulate future research to validate and improve such methods.