Making Implicit Assumptions Explicit in the Costing of Informal Care: The Case of Head and Neck Cancer in Ireland
From a health service perspective, informal care is often viewed as a potentially cost-effective way of transferring costs out of the formal healthcare sector. However, informal care is not a free resource.
Our objective was to assess the impact of alternative valuation methods and key assumptions on the cost of informal care.
Informal carers who assisted in the care of a head and neck cancer survivor for at least 1 year were sent a postal questionnaire during January–June 2014 requesting information on time spent on caring tasks in the month prior to the survey. Time was costed using the opportunity cost approach (OCA; base-case) and the generalist (GRCA) and specialist (SRCA) replacement cost approaches. The impact on results of how household work and informal carers not in paid employment are treated were investigated.
We estimated a cost of €20,613 annually in the base case (OCA – mean wage) for informal care. The GRCA and SRCA equivalent costs were 36% (€13,196) and 31% (€14,196) lower, respectively. In the extreme scenario of applying a ‘zero’ opportunity cost to carers not in paid employment, costs fell by 67% below the base case.
While the choice of costing method is important for monetary valuation, the sociodemographic and economic characteristics of the underlying population can be equally so. This is especially important given the heterogeneous treatment of older carers, female carers and carers not in paid employment in the OCA. To limit this, we would suggest using the SRCA to value informal care across heterogeneous carer populations.
Data Availability Statement
The datasets generated and analysed during the current study are not publicly available because of data protection restrictions. The study dataset includes data from the National Cancer Registry Ireland (NCRI); this is a Government body governed by statutory data protection guidelines. However, data may be formally requested from the NCRI subject to conditions.
The authors thank the health professionals involved in this project for facilitating the survivor survey and supporting the local ethics applications. We also thank Dr Aileen Timmons in her role as study co-ordinator and for undertaking the data collection. Finally, we also appreciate the helpful advice provided by Dr Rachael Gooberman-Hill and Dr Phyllis Butow as members of the steering committee on the SuN project.
PH conceived and designed the study. MB collected the sample data. PH, LS, RM, EOS and MB contributed to the development of paper structure. PH and LS contributed to the development of analysis strategy. PH ran the analysis. PH wrote the first draft, and all authors contributed to subsequent revisions. All authors contributed to the critical revision of intellectual content in the final manuscript. All authors approved the final version for submission.
Compliance with Ethical Standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was provided by all participating hospitals.
Informed consent was obtained from all individual participants included in the study.
Funding for the collection of the data used in this study was supplied by the Irish Health Research Board (HRA/2009/262; HRA/2009/262/R).
Conflicts of interest
Paul Hanly, Rebecca Maguire, Myles Balfe, Eleanor O’Sullivan and Linda Sharp have no conflicts of interest.
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