Willingness-to-pay for reductions in care need: estimating the value of informal care in Alzheimer's disease

Objective: To estimate the value of informal care in Alzheimer's disease using contingent valuation. Methods: A questionnaire was administered to 517 primary carers in four countries (UK, Spain, Sweden, and US). Dichotomous choice and bidding game methods were used to elicit their willingness to pay for a reduction in care burden by 1 h per day, or a total elimination of care needs. Further, the relationship between carer willingness to pay and carer and patient characteristics including disease severity and income was examined. Results: Carers spend on average about 7-9 h per day on giving care to their patient, of which 4-5 h constituted basic and instrumental ADL tasks. For a I h reduction in need for care per day, carers in the UK, Spain, Sweden, and US said that they were willing to pay 105, 121, 59, and 144 per month respectively. The willingness to pay was higher for carers with higher disposable income while the influence of other determinants varied across countries. About one-third of carers were not willing to pay anything for a reduction in care. Conclusions: Carers' stated willingness to pay for reductions in care giving time is substantial and comparable to the prices currently paid for treatments that achieve this benefit. Its determinants seem more directly related to carer status than directly to patient status and may vary by region and by cultural and sociologic factors. Copyright (C) 2009 John Wiley & Sons, Ltd.