The impact of indirect costs on outcomes of health care programs.

The impact of including indirect costs of disease (as a result of absence from work, disability and mortality) on outcomes of economic evaluations of specific health care programs is analyzed. For eight health care programs, changes in indirect costs are estimated using the friction cost method, that seeks to estimate the economic losses due to disease or the economic gains of health care programs. The impact of indirect costs on outcomes varies considerably across programs. Indirect costs tend to play an important role if health care programs produce health effects in the short run, if (short term) absence from work is affected considerably and if a significant proportion of the target population is employed at the moment they benefit from the program. The possible induction of treatment related absence from work and disability may also be relevant.