title: Measuring and Valuing Informal Care for Economic Evaluation of HIV/AIDS Interventions: Methods and Application in Malawi.
abstract: BACKGROUND
  Economic evaluation studies often neglect the impact of disease and ill health on the social network of people living with HIV (PLHIV) and the wider community. An important concern relates to informal care requirements which, for some diseases such as HIV/AIDS, can be substantial.
  
  
  OBJECTIVE
  To measure and value informal care provided to PLHIV in Malawi.
  
  
  METHODS
  A modified diary that divided a day into natural calendar changes was used to measure informal care time. The monetary valuation was undertaken by using four approaches: opportunity cost (official minimum wage used to value caregiving time), modified opportunity cost (caregiver's reservation wage), willingness to pay (amount of money caregiver would pay for care), and willingness to accept (amount of money caregiver would accept for providing care to someone else) approaches. Data were collected from 130 caregivers of PLHIV who were accessing antiretroviral therapy from six facilities in Phalombe district in southeast Malawi.
  
  
  RESULTS
  Of the 130 caregivers, 62 (48%) provided informal care in the survey week. On average, caregivers provided care of 8 h/wk. The estimated monetary values of informal care provided per week were US $1.40 (opportunity cost), US $2.41 (modified opportunity cost), US $0.40 (willingness to pay), and US $2.07 (willingness to accept).
  
  
  CONCLUSIONS
  Exclusion of informal care commitments may be a notable limitation of many applied economic evaluations. This work demonstrates that inclusion of informal care in economic evaluations in a low-income context is feasible.
authors.affiliation: Dignitas International, Zomba, Malawi; Department of Economics, University of Malawi, Zomba, Malawi. Electronic address: lschiwaula@cc.ac.mw.
authors.forename: Levison S
authors.initials: LS
authors.lastname: Chiwaula
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Revill
authors.affiliation: MRC Clinical Trials Unit at UCL, London, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: Ford
authors.affiliation: Dignitas International, Zomba, Malawi.
authors.forename: Misheck
authors.initials: M
authors.lastname: Nkhata
authors.affiliation: University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe.
authors.forename: Travor
authors.initials: T
authors.lastname: Mabugu
authors.affiliation: University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe.
authors.forename: James
authors.initials: J
authors.lastname: Hakim
authors.affiliation: Joint Clinical Research Centre, Kampala, Uganda.
authors.forename: Cissy
authors.initials: C
authors.lastname: Kityo
authors.affiliation: Dignitas International, Zomba, Malawi; Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Adrienne K
authors.initials: AK
authors.lastname: Chan
authors.affiliation: Dignitas International, Zomba, Malawi.
authors.forename: Fabian
authors.initials: F
authors.lastname: Cataldo
authors.affiliation: MRC Clinical Trials Unit at UCL, London, UK.
authors.forename: Diana
authors.initials: D
authors.lastname: Gibb
authors.affiliation: Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.
authors.forename: Bernard
authors.initials: B
authors.lastname: van den Berg
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000191:economics* / Q000628:therapy; D017028:Caregivers / Q000191:economics*; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006801:Humans; D008295:Malawi; D005791:Patient Care / Q000191:economics*
keywords: Africa; HIV/AIDS; cost-effectiveness; economic evaluation; informal care