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Completing Costs: Patientsí Time

Louise B. Russell

Medical Care
Every patient knows that taking care of oneís health and seeking medical care takes time, sometimes lots of it. Yet those who study the medical system rarely recognize the burden time requirements can be for patients. In a recent article, Louise Russell shows that the value of patientsí time can exceed the monetary costs of care and explains how to include it in studies of disease burden.

Objectives: To show the importance of patientsí time as a cost of health and medical care and to explain how to include it in costing studies without greatly increasing the work required for such studies.

Background: Despite the decade-old recommendation of the Panel on Cost-Effectiveness in Health and Medicine, patientsí time is rarely included in costing or cost-effectiveness analyses (CEAs). Studies of cancer care, smoking cessation, and diabetes self-management show that it can be a large part of an interventionís costs, sometimes larger than direct medical costs, and can potentially affect patientsí willingness to undertake the intervention.

Measuring and Valuing Time: Good costing practice follows 2 principles: measure all important uses of a resource; and value it appropriately and in a way that is consistent with the valuation of other resources. Counts of formal medical services, already measured in most studies, can serve as the starting point for valuing patientsí time, and would be a major step toward recognizing time costs, even when analysts cannot measure other uses of time. The concept of opportunity cost, often approximated by a market price, is the basis for valuing all resources. The reasons why the wage is a reasonable proxy for the value patients place on their own time are explained. Wage data are well measured and readily available.

Conclusions: Ignoring patientsí time underestimates disease burden and biases cost-effectiveness results toward interventions that use more time. The tools and data to include patientsí time are available and will improve if they are routinely used.

Louise B. Russell. "Completing Costs: Patientsí Time." Medical Care, Volume 47: S89-S93, 2009.