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Valuing care recipient and family caregiver time: A comparison of methods

Published online by Cambridge University Press:  24 January 2008

Denise N. Guerriere
University of Toronto
Jennifer E. Tranmer
University of British Columbia
Wendy J. Ungar
University of Toronto and The Hospital for Sick Children
Venika Manoharan
University of Toronto
Peter C. Coyte
University of Toronto


Objectives: The purpose of this study is to compare the approaches used for valuing family caregiver and care recipient time devoted to providing and receiving care.

Methods: Valuation approaches were operationalized within a cohort of cystic fibrosis care recipients (n = 110). Base-case analyses, grounded in human capital theory, applied earnings estimates to caregiving time to impute the market value of time lost from labor. Unpaid labor and leisure time was valued with a replacement cost (homemaker's wage rate). Total time costs were computed and sensitivity analyses were conducted to describe the effects of alternative valuation methods on total costs.

Results: The mean time cost per care recipient–caregiver dyad over 28 days was $2,026CAD. The majority (76 percent) of time costs were due to losses from unpaid labor and leisure time. Varying the valuation of paid labor time did not result in significantly different total time costs (p = .0877). However, varying the method of valuing unpaid labor and leisure time did significantly affect total costs (p < .0001).

Conclusions: Care recipients and caregivers primarily lost time from unpaid labor and leisure in the treatment of cystic fibrosis. Moreover, when the above losses were aggregated, the method of valuation greatly influenced overall results. The findings clearly indicate that omitting caregiver and unpaid labor and leisure costs may result in an inaccurate assessment of ambulatory and home-based healthcare programs.

Copyright © Cambridge University Press 2008

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1. Alcock, D, Danbrook, C, Walker, D, Hunt, C. Home care clients, providers and costs. Can J Public Health. 1998;89:297300.CrossRefGoogle ScholarPubMed
2. Bramwell, E, Halpin, D, Duncan-Skingle, F et al. Home treatment of patients with cystic fibrosis using the “Intermate”: The first year's experience. J Adv Nurs. 1995;22:10631067.CrossRefGoogle ScholarPubMed
3. Brouwer, WB, Koopmanschap, MA. How to calculate indirect costs in economic evaluations. Pharmacoeconomics 1998;13:563569.CrossRefGoogle ScholarPubMed
4. Browne, GB, Arpin, K, Corey, P et al. , Individual correlates of health services utilization and the cost of poor adjustment to chronic illness. Med Care. 1990;28:4358.CrossRefGoogle ScholarPubMed
5. Canadian Cystic Fibrosis Foundation. Report of the Canadian patient data registry. Canadian Cystic Fibrosis Foundation; 2000.Google Scholar
6. Chan, B, Coyte, PC, Heick, C. Economic impact of cardiovascular disease in Canada. Can J Cardiol. 1996;12:10001006.Google Scholar
7. Chappell, NL, Havens, B, Hollander, MJ et al. , Comparative costs of home care and residential care. Gerontologist. 2004;44:389400.CrossRefGoogle ScholarPubMed
8. Corey, M, Edwards, L, Levison, H, Knowles, M. Longitudinal analysis of pulmonary function decline in patients with cystic fibrosis. J Paediatr. 1997;131:809814.CrossRefGoogle ScholarPubMed
9. Coyte, PC, Young, W. Applied home care research. Int J Health Care Qual Assur Inc Leadersh Health Serv. 1997;10:i-iv.Google ScholarPubMed
10. Davis, P, Drumm, M, Konstan, M. Cystic Fibrosis. Am J Respir Crit Care Med. 1996;154:12291256.CrossRefGoogle ScholarPubMed
11. Di, Matteo L, Di, Matteo R. Public homecare expenditures in Canada. Can Public Policy. 2001;27:313333.Google Scholar
12. Drummond MF, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford: Oxford University Press; 1995.Google Scholar
13. Economist. Annual earnings data. The Economist; 2001.Google Scholar
14. Government of Canada: Ottawa. News Release: 2000 EI premium reduction. Available at: December 1, 2002.Google Scholar
15. Government of Canada: Ottawa. Schedule of Canada pension plan contribution rates. Available at: December 1, 2002.Google Scholar
16. Guerriere, D, Ungar, W, Corey, M et al. , Evaluation of the ambulatory and home care record: Agreement between self reports and administrative data. Int J Technol Assess Health Care. 2005;22:203210.CrossRefGoogle Scholar
17. Guerriere, D, Wong, A, Croxford, R et al. , Costs and determinants of privately-financed home-based health care in Ontario, Canada. Health Soc Care Community. In press.Google Scholar
18. Guerriere, DN, Tullis, E, Ungar, WJ et al. , Economic burden of ambulatory and home-based care. Treat Respir Med. 2006;5:351359.CrossRefGoogle ScholarPubMed
19. Ireys, HT, Anderson, GF, Shaffer, TJ, Neff, JM. Expenditures for care of children with chronic illnesses enrolled in the Washington State Medicaid program, fiscal year 1993. Pediatrics. 1997; 100 (pt 1):197204.CrossRefGoogle ScholarPubMed
20. Johnson, JA, Connolly, MA, Jacobs, P et al. Cost of care for individuals with cystic fibrosis in Alberta: A regression approach to determining important cost drivers. Alberta: Institute of Health Economics Working Paper, 99–2; 1999: 1–22.Google Scholar
21. Johnson, JA, Connolly, MA, Jacobs, P et al. , Cost of care for individuals with cystic fibrosis: A regression approach to determining the impact of recombinant human DNase. Pharmacotherapy. 1999;19:11591166.CrossRefGoogle ScholarPubMed
22. Koopmanschap, MA, Van, Ineveld BM. Towards a new approach for estimation indirect costs of disease. Soc Sci Med. 1992;34:10051010.CrossRefGoogle ScholarPubMed
23. Krauth, C, Jalilvand, N, Welte, T, Busse, R. Cystic fibrosis: Cost of illness and considerations for the economic evaluation of potential therapies. Pharmacoeconomics. 2003;21:10011024.CrossRefGoogle ScholarPubMed
24. LeLorier, J, Perreault, S, Birnbaum, H et al. , Savings in direct medical costs from the use of tobramycin solution for inhalation in patients with cystic fibrosis. Clin Ther. 2000;22:140151.Google Scholar
25. Leong, VW, Guerriere, DN, Croxford, R, Coyte, P. The magnitude, share and determinants of private costs incurred by clients (and their caregivers) of in-home publicly financed care. Healthcare Policy. In press.Google Scholar
26. Lieu, TA, Ray, GT, Farmer, G, Shay, GF. The cost of medical care for patients with cystic fibrosis in a health maintenance organization. Pediatrics. 1999;103:e72.CrossRefGoogle Scholar
27. McCance, K, Huether, S. Pathophysiology: The biological basis for disease in adults and children. Toronto: C.V. Mosby Company; 1991.Google Scholar
28. Nielsen, R, Gyrd-Hansen, D. Prenatal screening for cystic fibrosis: An economic analysis. Health Econ. 2002;11:285299.CrossRefGoogle ScholarPubMed
29. North York Community Care Access Centre, North York Community Care Access Centre.Google Scholar
30. Pauly, M. In: Lloyd-Still J, ed. Textbook of cystic fibrosis. Boston: John Wright PSG Inc; 1983.Google Scholar
31. Rothermich, EA, Pathak, DS. Productivity-cost controversies in cost-effectiveness analysis: Review and research agenda. Clin Ther. 1999;21:255267.CrossRefGoogle ScholarPubMed
32. Shepperd, S, Harwood, D, Gray, A et al. Randomised controlled trial comparing hospital at home care with inpatient hospital care. II. Cost minimisation analysis. BMJ. 1998;316:17911796.Google Scholar
33. Stastistics Canada. Consumer price index, historical summary, by province or territory. Montreal: Statistics Canada; 2006.Google Scholar
34. Stommel, M, Given, C, Given, B. The cost of cancer home care to families. Cancer. 1992;71:18671874.3.0.CO;2-7>CrossRefGoogle Scholar
35. Tullis, D, Guyatt, G. Quality of life in cystic fibrosis. Pharmacoeconomics 1995;8:2333.CrossRefGoogle ScholarPubMed
36. Van Den Berg, B, Brouwer, WBF, Koopmanschap, MA. Economic valuation of informal care: An overview of methods and applications. Eur J Health Econ. 2004;5:3645.CrossRefGoogle ScholarPubMed
37. Weinstein, MC, Siegel, JE, Gold, MR et al. , Recommendations of the panel on cost-effectiveness in health and medicine. JAMA. 1996;276:12531258.CrossRefGoogle ScholarPubMed
38. Wildhagen, MF, Verheij, JB, Verzijl, JG et al. , The nonhospital costs of care of patients with CF in The Netherlands: Results of a questionnaire. Eur Respir J. 1996;9:22152219.CrossRefGoogle ScholarPubMed
39. Wildhagen, MF, Verheij, JB, Verzijl, JG et al. , Cost of care of patients with cystic fibrosis in The Netherlands in 1990-1991. Thorax. 1996;51:298301.Google Scholar
40. Yates, B. Analyzing costs, procedures, processes and outcomes in human services. California: Sage Publications; 1997.Google Scholar
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