Objectives
Disease experience for people living with chronic diseases has changed dramatically with improvements in health utility. It remains unclear, however, the extent to which improvements in health utility leads to gains in work productivity and role functioning. This systematic literature review aimed to explore the relationship between health utility and work productivity or role functioning across chronic diseases.
Methods
Diseases selected were chronic and severe (based on health utility weights in range 0.50 to 0.70). Records from a structured search conducted in MEDLINE, Embase and PsycINFO were reviewed against inclusion criteria and assessed for study quality/relevance. Articles published from 2000 – February 2021 and available in English were considered. Studies included a measure of health utility (e.g., EQ-5D) and productivity or role function (e.g., employment status, presenteeism and absenteeism). Study quality was assessed in terms of design, analysis approach, missing data and evidence of bias.
Results
The search identified 876 records; 244 underwent full review, and 34 of the highest quality studies were extracted. Only 4 longitudinal studies were identified. Studies included different diseases including multiple sclerosis, rheumatoid arthritis, and stroke. Weighted mean health utilities of 0.79 were observed for employed (full/part time) people with a chronic disease, compared with 0.71 for part time employed, 0.61 for those unemployed/not in work, and 0.62 for those incapable of working. These associations held in studies controlling for potential confounders (e.g., age, symptom severity etc). Values corresponded to approximately a 5% increase in employment per 0.1 unit increase in health utility value.
Conclusions
There is limited longitudinal research among people with chronic diseases exploring how changes in health utility may lead to changes in work productivity and role functioning. However, the findings suggest that amongst people with a chronic and severe disease, better health states are expected to be associated with higher productivity.
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