Lost productivity of physical comorbidity in selected serious mental health conditions in Europe

Abstract Introduction People with mental health conditions (MHCs) are frequently unemployed and show high rates of absenteeism and presentism when employed. Indirect costs, including productivity losses, are large contributors to the economic burden of MHCs. Less is known on the implications of excess physical comorbidity. This study aimed to estimate total and excess lost productivity of excess physical health burden in selected serious MHCs. Methods We estimated productivity losses of excess physical comorbidity of individuals aged 20-64 years with alcohol use disorders (AUD), bipolar disorder (BD), depressive disorders (DD), and schizophrenia (SZ) across 312.5 million individuals in 32 European countries using purchasing power standard Euros (PPS€) for 2019. Lost productivity was based on absenteeism and presentism cases, and mortality related losses in the previous year. Input data were derived from the European Statistical Agency and recent epidemiological and health economic syntheses. Results Total annual productivity losses of physical comorbidity in selected serious MHCs were estimated 57.7 billion PPS€ (AUD), 23.3 billion PPS€ (BD), 89.2 billion PPS€ (DD), and 4.3 billion PPS€ (SZ) in Europe. Proportions of losses due to excess physical comorbidity was highest for BD at 48%, followed by DD at 41%, AUD at 40%, and SZ at 13%. At individual AUD, BD, DD and SZ diagnoses, these contribute to average excess costs of 1,098 PPS€, 1,513 PPS€, 1,154 PPS€, and 189 PPS€, respectively. Discussion This study is the first to comprehensively assess lost productivity of physical comorbidity in Europe. Losses correspond to 0.4% of included countries gross domestic product. Lower individual excess costs of SZ reflect lower employment rates and potential underdiagnosis of physical ill health. Health, social, and labour market policies are needed to address persisting physical health disparities in MHCs and further the (re-)integration into the labour market. Key messages • Lost productivity due physical ill health burden of people with selected serious mental health conditions corresponds to 0.4% of European countries’ gross domestic product. • Health, social, and labour market policies are needed for alleviating physical health disparities and improving labour market outcomes while achieving cost savings.