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Parental Health Spillover in Cost-Effectiveness Analysis: Evidence from Self-Harming Adolescents in England

Author

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  • Sandy Tubeuf

    (University of Leeds
    Université Catholique de Louvain)

  • Eirini-Christina Saloniki

    (University of Kent
    University of Kent)

  • David Cottrell

    (University of Leeds)

Abstract

Objective This article presents alternative parental health spillover quantification methods in the context of a randomised controlled trial comparing family therapy with treatment as usual as an intervention for self-harming adolescents, and discusses the practical limitations of those methods. Methods The trial followed a sample of 754 participants aged 11–17 years. Health utilities are measured using answers to the EuroQoL 5 Dimensions 3 Levels (EQ-5D-3L) for the adolescent and the Health Utility Index (HUI2) for one parent at baseline, 6 and 12 months. We use regression analyses to evaluate the association between the parent’s and adolescent’s health utilities as part of an explanatory regression model including health-related and demographic characteristics of both the adolescent and the parent. We then measure cost-effectiveness over a 12-month period as mean incremental cost-effectiveness ratios using various spillover quantification methods. We propose an original quantification based on the use of a household welfare function along with an equivalence scale to generate a health gain within the family to be added to the adolescent’s quality-adjusted life-year gain. Results We find that the parent’s health utility increased over the duration of the trial and is significantly and positively associated with adolescent’s health utility at 6 and 12 months but not at baseline. When considering the adolescent’s health gain only, the incremental cost-effectiveness ratio is £40,453 per quality-adjusted life-year. When including the health spillover to one parent, the incremental cost-effectiveness ratio estimates range from £27,167 per quality-adjusted life-year to £40,838 per quality-adjusted life-year and can be a dominated option depending on the quantification method used. Conclusion According to the health spillover quantification method considered, the incremental cost-effectiveness ratios vary from within the National Institute for Health and Care Excellence (NICE) cost-effectiveness threshold range to not being cost-effective.

Suggested Citation

  • Sandy Tubeuf & Eirini-Christina Saloniki & David Cottrell, 2019. "Parental Health Spillover in Cost-Effectiveness Analysis: Evidence from Self-Harming Adolescents in England," PharmacoEconomics, Springer, vol. 37(4), pages 513-530, April.
    • Handle: RePEc:spr:pharme:v:37:y:2019:i:4:d:10.1007_s40273-018-0722-6
    DOI: 10.1007/s40273-018-0722-6
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    References listed on IDEAS

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    1. Saskia Schawo & Renske Hoefman & Vivian Reckers-Droog & Liesbet Lawerman-van de Wetering & Yifrah Kaminer & Werner Brouwer & Leona Hakkaart-van Roijen, 2024. "Obtaining preference scores for an abbreviated self-completion version of the Teen-Addiction Severity Index (ASC T-ASI) to value therapy outcomes of systemic family interventions: a discrete choice ex," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(5), pages 903-913, July.
    2. María J. Mendoza-Jiménez & Job Exel & Werner Brouwer, 2024. "On spillovers in economic evaluations: definition, mapping review and research agenda," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(7), pages 1239-1260, September.
    3. Henry, Edward & Cullinan, John, 2021. "Mental health spillovers from serious family illness: Doubly robust estimation using EQ-5D-5L population normative data," Social Science & Medicine, Elsevier, vol. 279(C).
    4. Vivian Reckers-Droog & Maartje Goorden & Yifrah Kaminer & Lieke van Domburgh & Werner Brouwer & Leona Hakkaart-van Roijen, 2020. "Presentation and validation of the Abbreviated Self Completion Teen-Addiction Severity Index (ASC T-ASI): A preference-based measure for use in health-economic evaluations," PLOS ONE, Public Library of Science, vol. 15(9), pages 1-12, September.

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