Cost of informal care for patients with cardiovascular disease or diabetes: current evidence and research challenges

Abstract

Purpose Patients with cardiovascular disease (CVD) or diabetes often require informal care. The burden of informal care, however, was not fully integrated into economic evaluation. We conducted a literature review to summarize the current evidence on economic burden associated with informal care imposed by CVD or diabetes. Methods We searched EconLit, EMBASE, and PubMed for publications in English during the period of 1995 to 2015. Keywords for the search were informal care cost, costs of informal care, informal care, and economic burden. We excluded studies that (1) did not estimate monetary values, (2) examined methods or factors affecting informal care, or (3) did not address CVD or diabetes. Results Our search identified 141 potential abstracts and, 10 of the articles met our criteria. Although little research has been conducted, studies used different methods without much consensus, estimates suffered from recall bias, and study samples were small, the costs of informal care have been found high. In 2014 US dollars, estimated additional annual costs of informal care per patient ranged from $1,563 to $7,532 for stroke, $860 for heart failure, and $1,162 to $5,082 for diabetes. The total cost of informal care were ranged from $5,560 to $143,033 for stoke, $12,270 to $20,319 for heart failure, and $1,192 to $1,321 for diabetes. Conclusions The costs of informal care are substantial, and excluding them from economic evaluation would underestimate economic benefits of interventions for the prevention of CVD and diabetes.

Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association

“…Aside from this study and that reported by Joo and colleagues, 18,19,43 costs of informal caregiving associated with CVD are not well documented. Our estimates of the per-person hours of informal caregiving attributable to heart failure and stroke are consistent with previous studies.…”

“…78 For diabetes mellitus, the estimated annual costs of caregiving were reported to range from $1162 to $5082 per person. 43 As expected, the caregiving needs of Alzheimer disease bring the highest cost compared with those of stroke, mental illness, cancer, and multiple sclerosis. 55 However, detailed comparisons with other diseases that rely on consistent methodology are lacking.…”

“…43 However, the estimates presented here are likely conservative because care recipients usually understate impairment or disability compared with assessments by caregivers. [80][81][82] Furthermore, the self-reported data used in this analysis have also been previously used to estimate informal costs of caregiving for patients with heart failure, stroke, dementia, depression, and diabetes mellitus.…”

“…A recent review outlined the limitations of existing studies, including reliance on different methods, numerous biases, and small sample size. 43 Nevertheless, the estimated costs of informal care are high. As the need for methodological work is increasingly recognized, approaches to valuation of informal care are now being proposed, which will greatly contribute to addressing the recognized gaps in methodological knowledge and will therefore enhance the robustness of future analyses.…”

“…43 Joo and colleagues 43 recommended that future studies standardize methods for estimating costs of informal caregiving by (1) estimating disease-attributable cost rather than overestimating from multiple diseases per patient, (2) collecting patient-level data that include informal caregiver burden, (3) assessing a set of help areas rather than relying on memory, and (4) conducting sensitivity analyses. Of particular importance is collecting accurate hours of informal care with proper ways to estimate costs.…”