Utilization and Costs of Informal Caregiving Among Congestive Heart Failure Patients

The economic burden of congestive heart failure (CHF), a significant public health problem in the US, is estimated at $32 billion (including direct and indirect cost) in 2013.  However, there are a limited number of studies on indirect cost, and none of them explicitly investigated informal caregiving cost of CHF. We attempt to fill this gap by applying an econometric model to estimate the economic value of informal caregiving of patients with CHF.  Our data source was the 2010 Health and Retirement Study (HRS), a biennial longitudinal household survey for monitoring the health and well-being of those who are near or after retirement age in the US. Our study sample included non-institutionalized respondents aged 50 and older. Informal caregiving hours, the main dependent variable in this study, was defined as weekly caregiving hours provided mainly by family members of the patients. We defined CHF as ever having CHF (self-reported).  We used a two-part model to estimate the informal caregiving hours associated with CHF. The first part estimated the effect of CHF on the likelihood of receiving informal caregiving, and the second part estimated the effect of CHF on informal caregiving hours among those who received informal caregiving. Age, gender, marital status, education, self-reported health status, and usage of formal caregiving were control variables in both parts. We used a replacement approach to estimate the cost of informal caregiving associated with CHF assuming that informal caregivers replace those who are paid.  The prevalence of CHF was 3.9% (n=19,859), reflecting a weighted estimate of 3.6 million CHF patients aged 50 and older.  Patients with CHF used an average of 10.6 hours per week of informal caregiving services.  CHF patients were more likely to receive informal caregiving than people without CHF (Odds ratio: 1.72, p<0.001). CHF patients had an incremental increase of about 1.6 hours per week of informal caregiving (p<0.001).  CHF patients used 303 million hours of informal caregiving per year (1.6 hour/week, patient x 52 weeks x 3.6 million patients). Based on median wage of home health aide workers ($9.84/hour in 2010), the estimated annual informal caregiving cost attributable to CHF was $3.0 billion (303 million hours x $9.84/hour, 95% confidence interval: $1.7-4.5 billion). In conclusion, the cost of informal caregiving associated with CHF was high and should be included in indirect cost of CHF. Current estimated cost of CHF, $32 billion, underestimated the true cost by around 10% without informal caregiving cost. This information is helpful to public health decision makers in understanding the economic burden of CHF and in allocating resources for prevention of CHF.