Costs of informal care time are an important spillover effect that should be included in economic evaluations of health interventions if likely to be significant. |
Differences in methods and data sources make it difficult to compare estimates of informal care costs. |
Researchers who plan to include both caregiver health effects and time costs should choose methods that minimize double counting of spillover effects. |
1 Introduction
2 Measurement of Care Time
2.1 Diary and Recall Methods
2.1.1 Key Considerations and Potential Sources of Bias
3 Valuation
Valuation method | Advantages | Limitations | Examples |
---|---|---|---|
Revealed-preference methods | |||
Replacement cost (proxy good) | The market value of the task performed can be estimated once and used in different caregiving situations Double counting is not expected using this method, as it considers only the caregiver’s inputs | Lack of condition- and task-specific informal care hours Difficult to disentangle caregiving due to the condition vs. usual caregiving, especially of children or older adults By valuing all care hours equally, this method does not account for heterogeneity in informal care valuation May unrealistically assume that informal and professional care are perfect substitutes, i.e. this method does not account for differences in efficiency and quality of care given Does not account for the utility of the caregiver or care recipient Heterogeneity in estimates of replacement costs depending on data sources used | |
Opportunity cost | Straightforward to implement for caregivers in the labour market Double counting is not expected using this method, as it considers only the caregiver’s inputs | Caregivers not in the labour market do not have a market wage rate readily available to value the services, so wage rates must be imputed from other sources, e.g. from the general population of people with similar characteristics as the caregiver Requires that researchers ascertain which activities were displaced by informal care time, which may be feasible for acute events but not for chronic conditions Choice of imputation method can yield different estimates By valuing all care hours equally, this method does not account for heterogeneity in informal care valuation Ignores the utility that informal caregivers may get from providing care to relatives Difficult to disentangle caregiving due to the condition vs. usual caregiving, especially of children or older adults Does not account for differing utilities between different types of caregivers | |
Stated-preference methods | |||
Contingent valuation | Can be used to generate a monetary value to hypothetically value a non-market good May capture information on caregiver and patient preferences May capture heterogeneity in informal care valuation, i.e. informal care at the first hour can be valued differently from care given at the second and subsequent hours | Individual’s stated preferences may not be a good indicator of their own well-being, as other factors, such as the welfare of others, imperfect foresight, or irrational preferences, may affect stated preference Respondents’ stated intention may not translate to real behaviour Double counting may be a problem, as caregivers are assumed to account for the preferences and health of care recipients into the valuation | |
Conjoint analysis | Can be used to generate a monetary value to hypothetically value a non-market good May capture information on caregiver and patient preferences Can capture preferences on a different number of scenarios | As with contingent valuation, an individual’s stated preferences may not be a good indicator of their own well-being, as other factors, such as the welfare of others, imperfect foresight, or irrational preferences, may affect stated preference Method may be vulnerable to hypothetical bias Double counting may be a problem, as caregivers are assumed to account for the preferences and health of care recipients into the valuation Requires respondents to consider multiple attributes at the same time, which may be challenging |