We identified 30 US-based studies published between 2020 and 2024 that reported productivity-related outcomes, such as absenteeism, presenteeism, or unpaid non-market work productivity, and pertained to chronic, disabling, or high-burden conditions, such as Alzheimer’s disease [1, 11, 12, 26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52].

Table 2 summarizes productivity elements across four perspectives: patients, employers, society, and informal caregivers. Table 3 details the number and proportion of studies assessing specific productivity components, including absenteeism, presenteeism, unpaid non-market work productivity, and inclusion of fringe benefits. Overall, the TLR revealed substantial heterogeneity in how productivity losses were measured, valued, and reported across studies. These findings informed the topics explored during the expert workshop.

Although 77% of studies (23 of 30) assessed absenteeism [1, 11, 12, 26,27,28,29,30, 32,33,34, 37, 40, 43,44,45,46,47,48,49,50,51,52] and 37% (11 of 30) assessed presenteeism [27, 29, 30, 33, 41, 43, 45, 47, 48, 50, 52], definitions and measurement approaches varied substantially across studies. Absenteeism was more consistently measured using self-reported time-based metrics (e.g., number of hours or days absent), standardized survey instruments, and employer records or administrative data sources (e.g., disability claims) [1, 11, 12, 26,27,28,29,30, 32,33,34, 37, 40, 43,44,45,46,47,48,49,50,51,52]. Presenteeism was typically measured using self-reported reductions in productivity [26, 33, 48, 50, 52].

A range of instruments were used to measure productivity impact across multiple domains, including absenteeism, presenteeism, and unpaid non-market work productivity. The most frequently cited standardized instrument was the Work Productivity and Activity Impairment (WPAI) questionnaire, which captures absenteeism, presenteeism, and activity impairment related to unpaid non-market work productivity. Despite being a validated and widely used measure, the WPAI appeared in only 40% of studies (12 of 30), indicating limited adoption of standardized measurement approaches [1, 20, 28, 31, 35, 36, 38,39,40,41, 43, 47]. Other commonly used instruments included the Work Limitations Questionnaire, which focuses exclusively on presenteeism through on-the-job work limitations; the Health and Work Performance Questionnaire, which measures both absenteeism and presenteeism; and the Health-Related Productivity Loss Inventory, which has the broadest scope, capturing absenteeism, presenteeism, and two aspects of unpaid non-market work productivity: informal caregiver time and household production [43]. In addition to self-reported instruments, several studies also used administrative data sources, such as short-term disability claims, payroll records, and health surveillance systems, as well as national surveys like the Medical Expenditure Panel Survey and the American Productivity Audit [43].

Unpaid non-market work productivity was measured in 67% of studies (20 of 30), most commonly using surveys or other self-reported measures [12, 26, 28, 30,31,32,33,34,35,36,37,38,39,