The Canadian Partnership Against Cancer, Toronto, ON, Canada.
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, The University of Toronto, Toronto, ON, Canada.
Appl Health Econ Health Policy. 2021 May;19(3):325-341. doi: 10.1007/s40258-020-00619-z. Epub 2020 Dec 24.
Cancer poses a substantial health and economic burden on patients and caregivers in Canada. Previous reviews have estimated the indirect cost burden as work-related productivity losses associated with cancer. However, these estimates require updating and complementing with more comprehensive data that include relevant dimensions beyond labor market costs, such as patient time, lost leisure time and home productivity losses.
A systematic review of the literature was conducted to identify studies published from 2006 to 2020 that measured and reported the indirect costs borne by cancer patients and their caregivers in Canada, from the patient, caregiver, employer, and societal perspectives. Study characteristics and cost estimation methods were extracted from relevant studies. Costs estimates were reported and converted to 2020 CAD for the following categories: lost earnings, caregiving time costs, home production losses, patient time (leisure), morbidity-, disability-, premature mortality-related costs, friction costs, and overall productivity losses. A quality assessment of individual studies was conducted for included studies using the Newcastle-Ottawa Assessment Tool.
In total, 3980 studies were identified, of which 18 Canadian studies met the inclusion criteria for review. One-third of the studies used or developed prediction models, 38% enrolled patient cohorts, and 27% used administrative databases. Over one-third of the studies were conducted at a national level (38%). All studies employed the human capital approach to estimate costs, and 16% also used the friction cost approach. Lost earnings were higher among self-employed patients (43% vs 24% among employees) and females ($8200 vs $3200 for males). Caregiver costs ranged from $15,786 to $20,414 per patient per year. Household productivity losses were estimated to be up to $238,904 per household per year. Patient time (leisure) costs were estimated to be between $13,000 and $18,704 per patient per year. Premature annual mortality costs were estimated to be $2.98 billion overall in Quebec. Friction costs incurred by employers were estimated between $6400 and $23,987 per patient per year. Societal productivity losses associated with cancer were estimated between $75 million to $317 million, annually.
This review suggests that the indirect cost burden of cancer is considerable from the patient, caregiver, employer, and societal perspectives. This up-to-date review of the literature provides a comprehensive understanding of the indirect cost burden by including non-labor market activity costs and by examining all relevant perspectives. These results provide a strong case for the government and employers to ensure there are supports in place to help patients and caregivers buffer the impact of cancer so they can continue to engage in productive activities and enjoy leisure time.
癌症在加拿大给患者和护理人员带来了巨大的健康和经济负担。先前的综述估计了与癌症相关的间接成本负担是与工作相关的生产力损失。然而，这些估计需要更新，并辅以更全面的数据，包括劳动力市场成本以外的相关方面，如患者时间、休闲时间损失和家庭生产力损失。
对 2006 年至 2020 年期间发表的文献进行了系统综述，以确定测量和报告加拿大癌症患者及其护理人员从患者、护理人员、雇主和社会角度承担的间接成本的研究。从相关研究中提取了研究特征和成本估算方法。报告了成本估算，并转换为 2020 年加拿大元，用于以下类别：收入损失、护理时间成本、家庭生产损失、患者时间（休闲）、发病-残疾-过早死亡相关成本、摩擦成本和整体生产力损失。使用纽卡斯尔-渥太华评估工具对纳入研究进行了个体研究质量评估。
共确定了 3980 项研究，其中 18 项加拿大研究符合审查纳入标准。三分之一的研究使用或开发了预测模型，38%的研究纳入了患者队列，27%的研究使用了行政数据库。三分之一以上的研究在国家层面进行（38%）。所有研究都采用人力资本方法来估算成本，16%的研究还采用了摩擦成本方法。自营职业患者的收入损失更高（43%比员工的 24%），女性（男性为 8200 加元，女性为 3200 加元）。护理人员的成本每年从每位患者 15786 加元到 20414 加元不等。家庭生产力损失估计每年每户高达 238904 加元。患者时间（休闲）成本估计每年每位患者为 13000 至 18704 加元。魁北克省总体上估计过早年度死亡的成本为 29.8 亿美元。雇主承担的摩擦成本估计为每位患者每年 6400 至 23987 加元。与癌症相关的社会生产力损失估计每年为 7500 万至 3.17 亿加元。
本综述表明，从患者、护理人员、雇主和社会的角度来看，癌症的间接成本负担相当大。本文献综述的最新研究结果提供了对间接成本负担的全面理解，包括非劳动力市场活动成本，并从所有相关角度进行了研究。这些结果有力地证明了政府和雇主有责任确保为患者和护理人员提供支持，以帮助他们减轻癌症的影响，使他们能够继续从事生产性活动和享受休闲时间。
