title: Time costs associated with informal care for colorectal cancer: an investigation of the impact of alternative valuation methods.
abstract: BACKGROUND
  A societal perspective in economic evaluation necessitates that all resources associated with a disease or intervention should be valued; however, informal care time costs are rarely considered.
  
  
  OBJECTIVE
  We estimated time allocated to care by informal carers of colorectal cancer survivors; and investigated the impact of applying alternative valuation methods to this time.
  
  
  METHODS
  Colorectal cancer cases (ICD10 C18-C20) diagnosed 6-30 months previously and identified from the National Cancer Registry Ireland were invited to provide details of informal carers. Carers completed a postal questionnaire. Time estimates per week associated with hospital-related and domestic-related care activities were collected for two phases: diagnosis and initial treatment (initial 3 months) and ongoing care (previous 30 days). Seven valuation scenarios, based on variants of the opportunity cost approach (OCA), and the proxy good approach (PGA), were considered. The base-case was OCA with all carer time valued at the average national wage.
  
  
  RESULTS
  We received 154 completed questionnaires (response rate = 68 %). Average weekly time allocated to caring was 42.5 h in the diagnosis and initial treatment phase and 16.9 h in the ongoing care phase. Under the base-case, average weekly time costs were <euro>295 (95 % CI 255-344) for hospital-related activities and <euro>630 (95 % CI 543-739) for domestic-related activities in the diagnosis and initial treatment phase and <euro>359 (95 % CI 293-434) in the ongoing care phase. PGA estimates were 23 % below the base-case. Only one alternative scenario (occupation and gender-specific wages for carers in paid work and replacement wages for non-working carers) surpassed base-case costs, and the difference was modest.
  
  
  CONCLUSIONS
  Overall, significant time is associated with informal caring in colorectal cancer. Different time valuation methods can produce quite different cost estimates. A standardised methodology for estimating informal care costs would facilitate better integration of these into economic evaluations.
authors.affiliation: National Cancer Registry Ireland, Building 6800, Cork Airport Business Park, Kinsale Road, Cork, Ireland. paul.hanly@ncirl.ie
authors.forename: Paul
authors.initials: P
authors.lastname: Hanly
authors.forename: Alan Ó
authors.initials: AÓ
authors.lastname: Céilleachair
authors.forename: Mairead
authors.initials: M
authors.lastname: Skally
authors.forename: Eamonn
authors.initials: E
authors.lastname: O'Leary
authors.forename: Anthony
authors.initials: A
authors.lastname: Staines
authors.forename: Kanika
authors.initials: K
authors.lastname: Kapur
authors.forename: Patricia
authors.initials: P
authors.lastname: Fitzpatrick
authors.forename: Linda
authors.initials: L
authors.lastname: Sharp
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000191:economics*; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000191:economics* / Q000451:nursing*; D003365:Costs and Cost Analysis; D005260:Female; D017048:Health Care Costs; D006701:Home Nursing / Q000191:economics* / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged