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Hanly, Paul and Céilleachair, Alan O and Skally, Mairead and O'Leary, Eamonn and Staines, Anthony and Kapur, Kanika and Fitzpatrick, Patricia and Sharp, Linda
Applied Health Economics and Health Policy
Time costs associated with informal care for colorectal cancer: an investigation of the impact of alternative valuation methods
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BACKGROUND: A societal perspective in economic evaluation necessitates that all resources associated with a disease or intervention should be valued; however, informal care time costs are rarely considered. OBJECTIVE: We estimated time allocated to care by informal carers of colorectal cancer survivors; and investigated the impact of applying alternative valuation methods to this time. METHODS: Colorectal cancer cases (ICD10 C18-C20) diagnosed 6-30 months previously and identified from the National Cancer Registry Ireland were invited to provide details of informal carers. Carers completed a postal questionnaire. Time estimates per week associated with hospital-related and domestic-related care activities were collected for two phases: diagnosis and initial treatment (initial 3 months) and ongoing care (previous 30 days). Seven valuation scenarios, based on variants of the opportunity cost approach (OCA), and the proxy good approach (PGA), were considered. The base-case was OCA with all carer time valued at the average national wage. RESULTS: We received 154 completed questionnaires (response rate = 68 \%). Average weekly time allocated to caring was 42.5 h in the diagnosis and initial treatment phase and 16.9 h in the ongoing care phase. Under the base-case, average weekly time costs were \textlesseuro\textgreater295 (95 \% CI 255-344) for hospital-related activities and \textlesseuro\textgreater630 (95 \% CI 543-739) for domestic-related activities in the diagnosis and initial treatment phase and \textlesseuro\textgreater359 (95 \% CI 293-434) in the ongoing care phase. PGA estimates were 23 \% below the base-case. Only one alternative scenario (occupation and gender-specific wages for carers in paid work and replacement wages for non-working carers) surpassed base-case costs, and the difference was modest. CONCLUSIONS: Overall, significant time is associated with informal caring in colorectal cancer. Different time valuation methods can produce quite different cost estimates. A standardised methodology for estimating informal care costs would facilitate better integration of these into economic evaluations.
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