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Estimating the Cost of Informal Caregiving for Elderly Patients With Cancer

From the Department of Radiation Oncology; Division of General Medicine, Department of Medicine; Institute for Social Research; Veterans Affairs Center for Practice Management and Outcomes Research; Consortium for Health Outcomes, Innovation, and Cost-Effectiveness Studies; and Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI; and Ortho Biotech, Raritan, NJ.

Address reprint requests to James A. Hayman, MD, MBA, Department of Radiation Oncology, University of Michigan Health System, UH-B2C490, Box 0010, 1500 East Medical Center Dr, Ann Arbor, MI 48109; email: hayman{at}umich.edu

PURPOSE: As the United States population ages, the increasing prevalence of cancer is likely to result in higher direct medical and nonmedical costs. Although estimates of the associated direct medical costs exist, very little information is available regarding the prevalence, time, and cost associated with informal caregiving for elderly cancer patients.

MATERIALS AND METHODS: To estimate these costs, we used data from the first wave (1993) of the Asset and Health Dynamics (AHEAD) Study, a nationally representative longitudinal survey of people aged 70 or older. Using a multivariable, two-part regression model to control for differences in health and functional status, social support, and sociodemographics, we estimated the probability of receiving informal care, the average weekly number of caregiving hours, and the average annual caregiving cost per case (assuming an average hourly wage of $8.17) for subjects who reported no history of cancer (NC), having a diagnosis of cancer but not receiving treatment for their cancer in the last year (CNT), and having a diagnosis of cancer and receiving treatment in the last year (CT).

RESULTS: Of the 7,443 subjects surveyed, 6,422 (86%) reported NC, 718 (10%) reported CNT, and 303 (4%) reported CT. Whereas the adjusted probability of informal caregiving for those respondents reporting NC and CNT was 26%, it was 34% for those reporting CT (P < .05). Those subjects reporting CT received an average of 10.0 hours of informal caregiving per week, as compared with 6.9 and 6.8 hours for those who reported NC and CNT, respectively (P < .05). Accordingly, cancer treatment was associated with an incremental increase of 3.1 hours per week, which translates into an additional average yearly cost of $1,200 per patient and just over $1 billion nationally.

CONCLUSION: Informal caregiving costs are substantial and should be considered when estimating the cost of cancer treatment in the elderly.

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