Informal Care Costs According to Age and Proximity to Death to Support Cost-Effectiveness Analyses

BackgroundCosts of informal care are ignored in many cost-effectiveness analyses (CEAs) conducted from a societal perspective; however, these costs are relevant for lifesaving interventions targeted at the older population. In this study, we estimated informal care costs by age and proximity to death across European regions and showed how these estimates can be included in CEAs.MethodsWe estimated informal care costs by age and proximity to death using generalised linear mixed-effects models. For this, we selected deceased singles from the Survey of Health, Ageing and Retirement, which we grouped by four European regions. We combined the estimates of informal care costs with life tables to illustrate the impact of including informal care costs on the incremental cost-effectiveness ratio (ICER) of a hypothetical intervention that prevents a death at different ages.ResultsInformal care use, and hence informal care costs, increase when approaching death and with increasing age. The impact of including informal care costs on the ICER varies between euro200 and euro17,700 per quality-adjusted life-year gained. The impact increases with age and is stronger for women and in southern European countries.ConclusionOur estimates of informal care costs facilitate including informal care costs in CEAs of life-extending healthcare interventions. Including these costs may influence decisions as it leads to reranking of life-extending interventions compared with interventions improving quality of life.

Automated summary

This study estimated informal care costs by age and proximity to death across European regions and showed how these estimates can be included in cost-effectiveness analyses. The results indicated that the use and costs of informal care increase with age and approaching death, and including informal care costs in the cost-effectiveness ratio can have a significant impact ranging from euro200 to euro17,700 per quality-adjusted life-year gained. The conclusion of this study is that considering informal care costs is necessary as it may influence decision-making in life-extending healthcare interventions.