OBJECTIVES: Cancer-related indirect costs (ICs) have a major impact on healthcare systems, not only from the societal perspective but also from the patient and employer perspectives. Typically, economic evaluations have considered only productivity loss due to absenteeism from the societal perspective, which may substantially underestimate ICs. This study aimed to construct a cost-calculator to determine ICs in patients with cancer and compare results across various perspectives.

METHODS: A cost-calculator was developed using partition survival framework with three health states (progression free, progressive disease and death), one-week cycle length and 40-years’ time horizon. Various IC components including paid work (absenteeism, presenteeism, early retirement, premature mortality), unpaid/household work, and caregiver burden were considered. Human capital (HC) and friction cost (FC) approaches were used to calculate absenteeism-related cost; presenteeism costs were estimated by HC method. Cost losses from early retirement and premature mortality were estimated based on value of future lifetime earnings lost. Cost associated with household work was calculated by using both proxy-good and opportunity cost (OC) approaches. Inputs were collected from literature. Results were summarized for each perspective (patient, employer and societal) and presented for two treatments as incremental ICs.

RESULTS: Highest ICs were estimated using societal perspective followed by that of the patient and employer perspectives, irrespective of method used. Major drivers for higher ICs were early retirement and household work (OC approach) followed by absenteeism (HC approach) in both patient and societal perspectives. Whereas, absenteeism was the major driver of total IC from the employer perspective.

CONCLUSIONS: Considering only components like absenteeism may not provide a comprehensive estimate of the total ICs incurred. With the growing demand for patient-centered research to maximize the applicability of decisions, the need to include the appropriate components to accurately estimate ICs for the perspective taken is highlighted.