Scoping Review of Productivity-Adjusted Life Years (PALYs): Methods, Applications and Policy Implications

Zanfina Ademi (), Dina Abushanab, Maria J. Alfonso Arvez, Clara Marquina, Karl Vivoda, Janne Martikainen, Piia Lavikainen, Melanie Lloyd and Danny Liew
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Zanfina Ademi: Monash University
Dina Abushanab: Monash University
Maria J. Alfonso Arvez: Monash University
Clara Marquina: Monash University
Karl Vivoda: Monash University
Janne Martikainen: University of Eastern Finland
Piia Lavikainen: University of Eastern Finland
Melanie Lloyd: Monash University
Danny Liew: The University of Queensland

PharmacoEconomics, 2025, vol. 43, issue 12, No 1, 1367-1388

Abstract: Abstract Objective To understand the application of productivity-adjusted life years (PALYs) as an outcome measure across various disease contexts. Methods We conducted a scoping review of studies published between 2018 and April 2025 that utilised PALYs to illustrate their potential applications and identify methodological approaches that have been applied. Using a citation-based search, we selected studies that applied PALYs to quantify societal health burdens in specific diseases or contexts. Extracted data included health conditions, country, timeframe, model type, outcomes, productivity index components, gross domestic product and sensitivity analysis. Findings were summarised through narrative synthesis. Results A total of 41 studies conducted between 2018 and 2025 were reviewed, including chronic diseases such as diabetes and cardiovascular diseases, as well as environmental factors. Conditions such as breast cancer, leukaemia, kidney disease, mental health, knee osteoarthritis, epilepsy and sleep apnoea had the lowest productivity indices. Most of these studies originated from high-income countries (n = 27), followed by upper-middle-income (n = 10), and lower-middle-income (n = 4) settings. Life table models were the most common methodological approach adopted (n = 26), followed by dynamic models (n = 10). Studies focused on disease prevention (n = 21) outnumbered those addressing disease management (n = 18). Most studies accounted for both absenteeism and presenteeism (n = 30). Estimates of productivity loss per person using gross domestic product ranged from US$1137 to AU$217,983 annually. Conclusions PALYs have been utilised in diverse diseases and contexts, highlighting their utility in measuring societal health impacts. However, adding unpaid and informal work makes burden estimates more accurate. The increasing emphasis on prevention indicates a strategic change in health policy and economic assessment.

Date: 2025
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DOI: 10.1007/s40273-025-01544-6

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