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Spillover Effects on Caregivers’ and Family Members’ Utility: A Systematic Review of the Literature


  • Eve Wittenberg

    () (Harvard TH Chan School of Public Health)

  • Lyndon P. James

    (Harvard TH Chan School of Public Health)

  • Lisa A. Prosser

    (University of Michigan Medical School)


Background A growing body of research has identified health-related quality-of-life effects for caregivers and family members of ill patients (i.e. ‘spillover effects’), yet these are rarely considered in cost-effectiveness analyses (CEAs). Objective The objective of this study was to catalog spillover-related health utilities to facilitate their consideration in CEAs. Methods We systematically reviewed the medical and economic literatures (MEDLINE, EMBASE, and EconLit, from inception through 3 April 2018) to identify articles that reported preference-based measures of spillover effects. We used keywords for utility measures combined with caregivers, family members, and burden. Results Of 3695 articles identified, 80 remained after screening: 8 (10%) reported spillover utility per se, as utility or disutility (i.e. utility loss); 25 (30%) reported a comparison group, either population values (n = 9) or matched, non-caregiver/family member or unaffected individuals’ utilities (n = 16; 3 reported both spillover and a comparison group); and 50 (63%) reported caregiver/family member utilities only. Alzheimer’s disease/dementia was the most commonly studied disease/condition, and the EQ-5D was the most commonly used measurement instrument. Conclusions This comprehensive catalog of utilities showcases the spectrum of diseases and conditions for which caregiver and family members’ spillover effects have been measured, and the variation in measurement methods used. In general, utilities indicated a loss in quality of life associated with being a caregiver or family member of an ill relative. Most studies reported caregiver/family member utility without any comparator, limiting the ability to infer spillover effects. Nevertheless, these values provide a starting point for considering spillover effects in the context of CEA, opening the door for more comprehensive analyses.

Suggested Citation

  • Eve Wittenberg & Lyndon P. James & Lisa A. Prosser, 2019. "Spillover Effects on Caregivers’ and Family Members’ Utility: A Systematic Review of the Literature," PharmacoEconomics, Springer, vol. 37(4), pages 475-499, April.
  • Handle: RePEc:spr:pharme:v:37:y:2019:i:4:d:10.1007_s40273-019-00768-7
    DOI: 10.1007/s40273-019-00768-7

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    References listed on IDEAS

    1. Alastair Canaway & Hareth Al-Janabi & Philip Kinghorn & Cara Bailey & Joanna Coast, 2019. "Close-Person Spill-Overs in End-of-Life Care: Using Hierarchical Mapping to Identify Whose Outcomes to Include in Economic Evaluations," PharmacoEconomics, Springer, vol. 37(4), pages 573-583, April.
    2. 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.
    3. Janet MacNeil Vroomen & Judith E Bosmans & Iris Eekhout & Karlijn J Joling & Lisa D van Mierlo & Franka J M Meiland & Hein P J van Hout & Sophia E de Rooij, 2016. "The Cost-Effectiveness of Two Forms of Case Management Compared to a Control Group for Persons with Dementia and Their Informal Caregivers from a Societal Perspective," PLOS ONE, Public Library of Science, vol. 11(9), pages 1-20, September.
    4. Pei-Jung Lin & Brittany D’Cruz & Ashley A. Leech & Peter J. Neumann & Myrlene Sanon Aigbogun & Dorothee Oberdhan & Tara A. Lavelle, 2019. "Family and Caregiver Spillover Effects in Cost-Utility Analyses of Alzheimer’s Disease Interventions," PharmacoEconomics, Springer, vol. 37(4), pages 597-608, April.
    5. Emma Cowles & Grace Marsden & Amanda Cole & Nancy Devlin, 2017. "A Review of NICE Methods and Processes Across Health Technology Assessment Programmes: Why the Differences and What is the Impact?," Applied Health Economics and Health Policy, Springer, vol. 15(4), pages 469-477, August.
    6. Renske J. Hoefman & Job Exel & Werner B. F. Brouwer, 2017. "Measuring Care-Related Quality of Life of Caregivers for Use in Economic Evaluations: CarerQol Tariffs for Australia, Germany, Sweden, UK, and US," PharmacoEconomics, Springer, vol. 35(4), pages 469-478, April.
    7. Hareth Al-Janabi & Andrea Manca & Joanna Coast, 2017. "Predicting carer health effects for use in economic evaluation," PLOS ONE, Public Library of Science, vol. 12(9), pages 1-18, September.
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    Cited by:

    1. Edward J. D. Webb & John O’Dwyer & David Meads & Paul Kind & Penny Wright, 2020. "Transforming discrete choice experiment latent scale values for EQ-5D-3L using the visual analogue scale," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(5), pages 787-800, July.
    2. Lisa A. Prosser & Eve Wittenberg, 2019. "Advances in Methods and Novel Applications for Measuring Family Spillover Effects of Illness," PharmacoEconomics, Springer, vol. 37(4), pages 447-450, April.

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