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Family Spillover Effects in Pediatric Cost-Utility Analyses

Author

Listed:
  • Tara A. Lavelle

    (Tufts Medical Center)

  • Brittany N. D’Cruz

    (Tufts Medical Center)

  • Babak Mohit

    (Tufts Medical Center)

  • Wendy J. Ungar

    (The Hospital for Sick Children Research Institute
    University of Toronto)

  • Lisa A. Prosser

    (University of Michigan)

  • Kate Tsiplova

    (The Hospital for Sick Children Research Institute)

  • Montserrat Vera-Llonch

    (Global Health Economics Outcomes Research and Epidemiology)

  • Pei-Jung Lin

    (Tufts Medical Center)

Abstract

Background Childhood illness can impose significant costs and health strains on family members, but these are not routinely captured by pediatric economic evaluations. This review investigated how family “spillover effects” related to costs and health outcomes are considered in pediatric cost-utility analyses (CUAs). Methods We reviewed pediatric CUAs published between 2000 and 2015 using the Tufts Medical Center Cost-effectiveness Analysis (CEA) Registry and the Pediatric Economic Database Evaluation (PEDE) Registry. We selected studies conducted from the societal perspective and included in both registries. We investigated how frequently family spillover was incorporated into analyses, and how the inclusion of spillover health effects and costs changed CUA results. Results We found 142 pediatric CUAs meeting inclusion criteria. Of those, 105 (72%) considered either family spillover costs (n = 98 time costs, n = 33 out-of-pocket costs, n = 2 caregiver healthcare costs) or health outcomes (n = 15). Twenty-four studies included 43 pairs of incremental cost-effectiveness ratios (ICERs) with and without spillover. In 19 pairs of ICERs, adding spillover changed the ICER enough to cross a common cost-effectiveness threshold (i.e., $50,000/QALY, $100,000/QALY, $150,000/QALY; values are in 2016 US$). Incorporating spillover generally made interventions more cost-effective (n = 18; 42%), or did not change CUA results enough to cross a threshold (n = 24; 56%). Including family spillover reduced ICERs by 31% ($40,000/QALY) on average. Conclusion Most pediatric CUAs conducted from a societal perspective include family costs but fewer include family health effects. Inclusion of family spillover effects tends to make CUA results more favorable. Future pediatric CUAs should aim to more fully incorporate the family burden of illness.

Suggested Citation

  • Tara A. Lavelle & Brittany N. D’Cruz & Babak Mohit & Wendy J. Ungar & Lisa A. Prosser & Kate Tsiplova & Montserrat Vera-Llonch & Pei-Jung Lin, 2019. "Family Spillover Effects in Pediatric Cost-Utility Analyses," Applied Health Economics and Health Policy, Springer, vol. 17(2), pages 163-174, April.
  • Handle: RePEc:spr:aphecp:v:17:y:2019:i:2:d:10.1007_s40258-018-0436-0
    DOI: 10.1007/s40258-018-0436-0
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    References listed on IDEAS

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    1. Brouwer, Werner B.F. & Exel, N. Job A. van & Berg, Bernard van den & Bos, Geertruidis A.M. van den & Koopmanschap, Marc A., 2005. "Process utility from providing informal care: the benefit of caring," Health Policy, Elsevier, vol. 74(1), pages 85-99, September.
    2. Tara Lavelle & Eve Wittenberg & Kara Lamarand & Lisa Prosser, 2014. "Variation in the Spillover Effects of Illness on Parents, Spouses, and Children of the Chronically Ill," Applied Health Economics and Health Policy, Springer, vol. 12(2), pages 117-124, April.
    3. Eve Wittenberg & Adrianna Saada & Lisa Prosser, 2013. "How Illness Affects Family Members: A Qualitative Interview Survey," The Patient: Patient-Centered Outcomes Research, Springer;International Academy of Health Preference Research, vol. 6(4), pages 257-268, December.
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    Cited by:

    1. Nishit Dhanji & Werner Brouwer & Cam Donaldson & Eve Wittenberg & Hareth Al‐Janabi, 2021. "Estimating an exchange‐rate between care‐related and health‐related quality of life outcomes for economic evaluation: An application of the wellbeing valuation method," Health Economics, John Wiley & Sons, Ltd., vol. 30(11), pages 2847-2857, November.
    2. Al-Janabi, Hareth & Wittenberg, Eve & Donaldson, Cam & Brouwer, Werner, 2022. "The relative value of carer and patient quality of life: A person trade-off (PTO) study," Social Science & Medicine, Elsevier, vol. 292(C).

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