The Indirect Cost Burden of Cancer Care in Canada: A Systematic Literature Review

Applied Health Economics and Health Policy https://doi.org/10.1007/s40258-020-00619-z SYSTEMATIC REVIEW The Indirect Cost Burden of Cancer Care in Canada: A Systematic Literature Review Nicolas Iragorri1,2,4 · Claire de Oliveira1,2,3 · Natalie Fitzgerald1 · Beverley Essue1,2 Accepted: 21 October 2020 © The Author(s) 2020 Abstract Background and objectives Cancer poses a substantial health and economic burden on patients and caregivers in Canada. Previous reviews have estimated the indirect cost burden as work-related productivity losses associated with cancer. However, these estimates require updating and complementing with more comprehensive data that include relevant dimensions beyond labor market costs, such as patient time, lost leisure time and home productivity losses. Methods A systematic review of the literature was conducted to identify studies published from 2006 to 2020 that measured and reported the indirect costs borne by cancer patients and their caregivers in Canada, from the patient, caregiver, employer, and societal perspectives. Study characteristics and cost estimation methods were extracted from relevant studies. Costs estimates were reported and converted to 2020 CAD for the following categories: lost earnings, caregiving time costs, home production losses, patient time (leisure), morbidity-, disability-, premature mortality-related costs, friction costs, and overall productivity losses. A quality assessment of individual studies was conducted for included studies using the Newcastle–Ottawa Assessment Tool. Results In total, 3980 studies were identified, of which 18 Canadian studies met the inclusion criteria for review. One-third of the studies used or developed prediction models, 38% enrolled patient cohorts, and 27% used administrative databases. Over one-third of the studies were conducted at a national level (38%). All studies employed the human capital approach to estimate costs, and 16% also used the friction cost approach. Lost earnings were higher among self-employed patients (43% vs 24% among employees) and females ($8200 vs $3200 for males). Caregiver costs ranged from $15,786 to $20,414 per patient per year. Household productivity losses were estimated to be up to $238,904 per household per year. Patient time (leisure) costs were estimated to be between $13,000 and $18,704 per patient per year. Premature annual mortality costs were estimated to be $2.98 billion overall in Quebec. Friction costs incurred by employers were estimated between $6400 and $23,987 per patient per year. Societal productivity losses associated with cancer were estimated between $75 million to $317 million, annually. Conclusions This review suggests that the indirect cost burden of cancer is considerable from the patient, caregiver, employer, and societal perspectives. This up-to-date review of the literature provides a comprehensive understanding of the indirect cost burden by including non-labor market activity costs and by examining all relevant perspectives. These results provide a strong case for the government and employers to ensure there are supports in place to help patients and caregivers buffer the impact of cancer so they can continue to engage in productive activities and enjoy leisure time. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40258-020-00619-z) contains supplementary material, which is available to authorized users. * Nicolas Iragorri Extended author information available on the last page of the article Vol.:(0123456789) N. Iragorri et al. Key Points for Decision Makers Cancer patients, their caregivers, and employers bear a considerable indirect cost burden related to cancer care in Canada. The indirect cost burden of cancer is not limited to the productive labor market costs incurred by patients. Patient leisure time and home-production losses are important cost categories that must be considered when measuring the indirect cost burden. The caregivers of pediatric patients, women, younger patients, and those who were self-employed face higher indirect costs in Canada. 1 Introduction Cancer is a common chronic disease that has a large impact globally, including in Canada. Around half of the population is expected to develop cancer in their lifetime [1], and it remains the leading cause of premature mortality [2]. Furthermore, cancer poses a substantial health and economic burden on patients, their caregivers, and the healthcare system, given its high incidence (over 200,000 cases per year in 2019), long-term health effects, and rising treatment costs [3]. The economic burden is typically conceptualized as three distinct categories: direct, indirect, and psychosocial [4]. Cost of illness studies are often conducted to estimate the direct and indirect costs associated with a given disease; in turn, these estimates are used to support cost-effectiveness analyses, which are critical for informing resource allocation decisions [5]. Although the direct burden of cancer in Canada has been previously described [6], evidence around the indirect costs associated with cancer care is sparse and limited. The indirect burden includes the monetary losses associated with lost patient/caregiver time and lost opportunities due to disease morbidity and related premature mortality (also defined as opportunity costs) [7]. These costs are incurred by patients, caregivers, employers, and society as a whole; however, because lost opportunities are usually not reflected in monetary transactions, the value of the time lost must be approximated. Thus, to obtain an overall estimate of the indirect cost burden, the time that cancer patients spend in obtaining treatment, loss from not working due to shortor long-term cancer-related disability, and the lost productivity due to premature death are monetized and combined [7]. In a report conducted by the Public Health Agency of Canada, work-related productivity losses due to cancer were estimated to be $586,000,000 in 2008 [8]. Subsequently, a review conducted in 2010 identified studies published before 2008 that had estimated wage losses due to cancer [9] and found that newly diagnosed cancers in Canada generated an average wage loss of $3.18 billion per year. However, these studies only included labor market-related production losses. Considering the lack of up-to date and comprehensive estimates, and the fast pace at which cancer care has evolved in the last decade [10], the evidence around the indirect cost burden of cancer in Canada needs to be re-evaluated to include recent studies that also capture non-labor market activities, such as home production, leisure, and caregiving time. Therefore, the aim of this review was to evaluate the most recent Canadian literature on the indirect cost burden associated with cancer from the perspectives of patients, families, caregivers, employers, and society. 2 Methods 2.1 Data Sources and Search Strategies A system (...truncated)