Time is money—or is it?

In this issue of Neurology, Hickenbottom et al. estimate the annual costs of informal care for elderly patients with stroke in the United States to be $6 billion.1 This estimate was based on interview data from a representative cohort of the community-dwelling US elderly population aged 70 and over. This estimate would presumably be higher if younger community-dwelling patients as well as institutionalized patients (many of whom receive some unpaid caregiving) were also included. Nevertheless, informal caregiving costs for stroke would not likely exceed 20% of the recent estimate of $43 billion for other direct and indirect costs of stroke care in the United States.2

In deriving their estimate, the authors make several assumptions: 1) respondent (or proxy) reports of physician-diagnosed stroke are accurate; 2) respondents (or their proxies) accurately report the hours of informal care; 3) statistical adjustment for various covariates associated with the use of informal care allows accurate quantification of the additional hours of informal care attributable specifically to stroke; 4) all individuals surveyed live a full year, and their informal caregiving is constant over the year; and 5) the opportunity cost of informal caregiving provided by a retired elderly person is the same as the national median wage for a home health aide. Although these assumptions could be tested and refined, the authors’ assumptions are typical of similar studies for other conditions (e.g., AD). Certainly, the authors’ estimate of less …