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.

中文翻译：

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加拿大癌症护理的间接成本负担：系统文献综述

背景和目标

癌症给加拿大的患者和护理人员带来了巨大的健康和经济负担。之前的评论已经将间接成本负担估计为与癌症相关的与工作相关的生产力损失。然而，这些估计需要更新和补充更全面的数据，这些数据包括劳动力市场成本以外的相关维度，例如患者时间、休闲时间损失和家庭生产力损失。

方法

对文献进行了系统审查，以确定 2006 年至 2020 年发表的研究，这些研究从患者、护理人员、雇主和社会的角度衡量和报告了加拿大癌症患者及其护理人员承担的间接成本。从相关研究中提取研究特征和成本估算方法。报告了以下类别的成本估算并转换为 2020 年加元：收入损失、护理时间成本、家庭生产损失、患者时间（休闲）、发病率、残疾、过早死亡相关成本、摩擦成本和整体生产力损失. 使用纽卡斯尔-渥太华评估工具对纳入的研究进行了单个研究的质量评估。

结果

总共确定了 3980 项研究，其中 18 项加拿大研究符合纳入审查标准。三分之一的研究使用或开发了预测模型，38% 的研究纳入了患者队列，27% 的研究使用了管理数据库。超过三分之一的研究是在国家层面进行的（38%）。所有研究均采用人力资本法来估算成本，16% 的研究还使用摩擦成本法。自雇患者（43% 对雇员的 24%）和女性（8200 美元对男性 3200 美元）的收入损失更高。每位患者每年的护理费用从 15,786 美元到 20,414 美元不等。家庭生产力损失估计高达每户每年 238,904 美元。每位患者每年的患者时间（休闲）成本估计在 13,000 美元至 18,704 美元之间。在魁北克，每年过早死亡的费用估计为 29.8 亿加元。雇主产生的摩擦成本估计在每位患者每年 6400 至 23,987 美元之间。与癌症相关的社会生产力损失估计每年在 7500 万至 3.17 亿美元之间。

结论

本综述表明，从患者、护理人员、雇主和社会的角度来看，癌症的间接成本负担是相当大的。这篇最新的文献综述通过包括非劳动力市场活动成本和检查所有相关观点，提供了对间接成本负担的全面理解。这些结果为政府和雇主提供了强有力的理由，以确保有到位的支持来帮助患者和护理人员缓冲癌症的影响，以便他们能够继续从事生产活动并享受休闲时光。