• Brystana G Kaufman, Wenhan Zhang, Sahar Shibeika, Ro W Huang, Ting Xu, Cory Ingram, Allison M Gustavson, Diane E Holland, Catherine Vanderboom, Courtney H Van Houtven, and Joan M Griffin.
• Population Health Sciences (B.G.K., W.Z., S.S., T.X., C.H.V.H.), Duke University School of Medicine, Durham, North Carolina, USA; Margolis Institute for Health Policy (B.G.K., R.W.H., C.H.V.H.), Duke University, Durham, North Carolina, USA; Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) (B.G.K., C.H.V.H.), Durham VA Medical Center, Durham, North Carolina, USA. Electronic address: brystana.kaufman@duke.edu.
• J Pain Symptom Manage. 2024 Dec 1; 68 (6): 632640.e2632-640.e2.

ContextFamily caregivers (FCGs) play a crucial role in care for people with serious illness, yet unpaid care is often overlooked in estimates of care recipient (CR) care costs.ObjectivesThis study quantifies the economic value of unpaid caregiving by FCGs between hospital discharge and end of life.MethodsTrial participants were rural FCGs of CRs receiving palliative care during hospitalization. Caregiving hours were self-reported by FCGs over six months following hospital discharge. Economic value was assigned to hours based on wage data from the United States Bureau of Labor Statistics. Time was valued using 1) home health aide wages (proxy cost), 2) median national wage by FCG sex and education level (opportunity cost), 3) opportunity cost if employed and proxy cost otherwise (combination cost).ResultsOf 282 FCGs, 94% were non-Hispanic White, 71% were female, 71% had a college degree, and 51% were in the workforce. FCGs of decedents (58%) compared to survivors reported significantly more caregiving hours per person-month (392 vs. 272), resulting in higher estimated economic value per person-month using opportunity ($12,653 vs. $8843), proxy ($5689 vs. $3955), and combined costing methods ($9490 vs. $6443) CONCLUSION: This study informs more complete economic evaluations of palliative care by estimating the economic value of unpaid caregiving. The high intensity of unpaid caregiving for people with serious illness, especially toward the end of life, should be considered when designing policies and interventions to support FCGs. Better methods for approximating economic value are needed to address potential inequities in current valuation approaches.Published by Elsevier Inc.

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