Indirect Costs of Non-Communicable Diseases within the Top Ten Causes of Mortality Worldwide: A Systematic Literature Review.

Background: Chronic non-communicable diseases (NCDs) are a major public health challenge, representing the leading cause of disability and premature mortality worldwide. Beyond direct medical expenses, NCDs generate substantial indirect costs through productivity losses and reduced workforce participation. This study aims to identify the indirect costs reported in scientific literature on NCDs in the economically active population between 2012 and 2022. Methods: A systematic literature review covering 2012 to 2025 was conducted in PubMed/MEDLINE, PubMed Central (PMC), Embase, Web of Science, and Scopus. Only primary studies in English or Spanish were included, and independent reviews were conducted by two authors. Results: Of 1980 identified articles, 42 met the inclusion criteria. Indirect costs were mainly represented by productivity losses (absenteeism and presenteeism) and disease burden measured with Disability-Adjusted Life Years (DALYs). The highest volume of research focused on ischemic heart disease, stroke, and chronic obstructive pulmonary disease. Conclusion: Evidence on indirect costs of NCDs remains limited despite their significant economic and social impact. These conditions reduce both the quality and availability of the workforce and generate high indirect costs. Addressing these challenges requires strategies across all levels of prevention, not only within healthcare systems but also in workplaces, to mitigate the economic burden of NCDs on the economically active population.