Hanly Paul, Maguire Rebecca, Balfe Myles, O'Sullivan Eleanor, Sharp Linda
National College of Ireland, Mayor Street, Dublin 1, Ireland.
University College Cork, Cork, Ireland.
Pharmacoeconomics. 2017 May;35(5):591-601. doi: 10.1007/s40273-017-0490-8.
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.
从卫生服务的角度来看，非正式照护通常被视为一种将成本从正规医疗保健部门转移出去的潜在成本效益方式。然而，非正式照护并非免费资源。
我们的目的是评估替代估值方法和关键假设对非正式照护成本的影响。
2014年1月至6月期间，向协助头颈癌幸存者护理至少1年的非正式照护者发送了一份邮政调查问卷，要求提供在调查前一个月用于护理任务的时间信息。使用机会成本法（OCA；基础案例）以及通才替代成本法（GRCA）和专家替代成本法（SRCA）对时间进行成本核算。研究了家务劳动以及无薪就业的非正式照护者的处理方式对结果的影响。
在基础案例（OCA - 平均工资）中，我们估计非正式照护的年度成本为20,613欧元。GRCA和SRCA的等效成本分别低36%（13,196欧元）和31%（14,196欧元）。在对无薪就业的照护者应用“零”机会成本的极端情况下，成本比基础案例下降了67%。
虽然成本核算方法的选择对于货币估值很重要，但潜在人群的社会人口和经济特征同样重要。鉴于OCA中对老年照护者、女性照护者和无薪就业照护者的不同处理方式，这一点尤为重要。为了限制这一点，我们建议使用SRCA对不同照护人群的非正式照护进行估值。
