Economic valuation of informal care in cerebrovascular accident survivors in Spain

BMC Health Services Research Economic valuation of informal care in cerebrovascular accident survivors in Spain Juan Oliva-Moreno 0 1 3 Isaac Aranda-Reneo 2 Cristina Vilaplana-Prieto 5 Almudena Gonzlez-Domnguez 4 lvaro Hidalgo-Vega 1 0 Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC) , Toledo , Spain 1 Department of Economic and Financial Analysis, Faculty of Legal and Social Sciences, University of Castilla-La Mancha , Toledo , Spain 2 Department of Economic and Financial Analysis, Facultad de Ciencias Juridicas y Sociales, Universidad de Castilla-La Mancha, Cobertizo San Pedro , Martir, Toledo s/n 45071 , Spain 3 Red de Investigacion en Servicios de Salud en Enfermedades Cronicas (REDISSEC) , Toledo , Spain 4 Biostatistics Department, Max Weber Institute , Majadahoda, (Madrid) , Spain 5 University of Murcia , Murcia , Spain Background: Cerebrovascular diseases are the second leading cause of death worldwide and one of the health conditions which demand the highest level of social services. The aim of this study was to estimate the social cost of non-professional (informal) care provided to survivors of cerebrovascular accidents (CVA) with some type of disability in Spain. Methods: We obtained data from the 2008 Survey on Disability, Independent Living and Dependency (EDAD-08) on the main characteristics of individuals who provide informal care to survivors of CVAs in Spain. We estimated the cost of substituting informal care in favor of formal care provided by professional caregivers (proxy good method) and performed a statistical analysis of the relationship between degree of dependency and number of care hours provided using ordinary least squares regression. Results: The number of disabled people diagnosed with CVA totaled 1,975 (329,544 people when extrapolating to the national population using the elevation factor provided by EDAD-08). Of these, 1,221 individuals (192,611 people extrapolated to the national population) received at least one hour of informal care per week. The estimated hours of informal care provided in 2008 amounted to 852 million. The economic valuation of the time of informal care ranges from 6.53 billion euros (at 7.67 euros/hour) to 10.83 billion euros (when calculating each hour of care at 12.71 euros). The results of our statistical analysis highlight the importance of degree of dependency in explaining differences in the number of hours of informal care provided. Conclusions: The results of our study reveal the high social cost of cerebrovascular accidents in Spain. In addition, evidence is presented of a correlation between higher degree of dependency in CVA survivors and greater number of hours of care received. An integral approach to care for CVA survivors requires that the caregivers' role and needs be taken into account. - Background Cerebrovascular diseases (CVD) are the second leading cause of death after ischemic heart disease (IHD), and the third leading cause of disability-adjusted life years in highincome countries after IHD and lower respiratory infections. The World Health Organization estimated that in 2010 CVD caused 5.87 million deaths across the globe (11% of all causes of death) and 102 million disabilityadjusted life years [1,2]. In Spain, CVA is the leading cause of death among women and the third among men [3]. In addition to deaths, the effects of the disease on survivors and consequentially the loss in quality of life must be taken into consideration when assessing its impact [4,5]. People who survive a CVA usually suffer negative long-term effects which, in many cases, reduce the persons autonomy and lead to functional dependency [6]. Reviews of CVA cost studies report that there are fewer economic analyses of the costs of CVA than there are for other diseases [7-9]. However, the available studies stress that CVA is an acute and highly costly condition which accounts for a significant portion of overall healthcare spending. Evers et al. estimated that 3-4% of health spending in high-income countries is spent on CVA, mainly reflecting the direct cost of hospitalization during the first year of survival [9]. However, studies that address the cost of CVA from a broader (social) perspective indicate that non-medical costs (formal and informal care and productivity losses) may far outstrip medical costs [10-13]. As far as we know, only one study published to date has applied a cost-of-illness design using a national sample to CVD in Europe [14]. This study revealed that nonhealthcare costs accounted for 38.9% of the overall costs of the disease, with informal care being the most substantial item among non-healthcare costs (54.4% of this item). Studies which calculate such global estimates are uncommon in the literature, since they require very rich sources of data. In Spain, research has been published describing informal care in patients who have had a CVA, although these studies were either performed on small samples (...truncated)