National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS E-87, Atlanta, GA, 30341, USA.
Immunization Services Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Pharmacoeconomics. 2019 Apr;37(4):461-473. doi: 10.1007/s40273-019-00782-9.
Spillover effects on the welfare of family members may refer to caregiver health effects, informal care time costs, or both. This review focuses on methods that have been used to measure and value informal care time and makes suggestions for their appropriate use in cost-of-illness and cost-effectiveness analyses. It highlights the importance of methods to value informal care time that are independent of caregiver health effects in order to minimize double counting of spillover effects. Although the concept of including caregiver time costs in economic evaluations is not new, relatively few societal perspective cost-effectiveness analyses have included informal care, with the exception of dementia. This is due in part to challenges in measuring and valuing time costs. Analysts can collect information on time spent in informal care or can assess its impact in displacing other time use, notably time in paid employment. A key challenge is to ensure appropriate comparison groups that do not require informal care to be able to correctly estimate attributable informal care time or foregone market work. To value informal care time, analysts can use estimates of hourly earnings in either opportunity cost or replacement cost approaches. Researchers have used widely varying estimates of hourly earnings. Alternatively, stated-preference methods (i.e. contingent valuation, conjoint analysis) can be used to value the effect of informal care on utility, but this can entail double counting with health effects. Lack of consensus and standardization of methods makes it difficult to compare estimates of informal care costs.
家庭成员的溢出效应可能指的是照顾者的健康影响、非正式护理时间成本，或两者兼而有之。本综述重点介绍了用于衡量和评估非正式护理时间价值的方法，并就其在疾病成本和成本效益分析中的适当应用提出了建议。它强调了在最小化溢出效应重复计算的情况下，独立于照顾者健康影响来评估非正式护理时间价值的方法的重要性。虽然将照顾者时间成本纳入经济评估的概念并不新鲜，但相对较少有从社会角度出发的成本效益分析包括非正式护理，除了痴呆症。部分原因是衡量和评估时间成本存在挑战。分析人员可以收集有关非正式护理时间的信息，或者评估其对替代其他时间用途（尤其是有偿工作时间）的影响。一个关键挑战是确保使用不需要非正式护理的适当对照组，以正确估计归因于非正式护理的时间或错过的市场工作时间。为了评估非正式护理时间的价值，分析人员可以在机会成本或重置成本方法中使用每小时收入的估计值。研究人员使用了广泛不同的每小时收入估计值。或者，可以使用陈述偏好方法（即意愿评估、联合分析）来评估非正式护理对效用的影响，但这可能会与健康影响重复计算。方法缺乏共识和标准化，使得难以比较非正式护理成本的估计值。
