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Modelling Spillover Effects on Informal Carers: The Carer QALY Trap

Author

Listed:
  • David J. Mott

    (Office of Health Economics)

  • Hannah Schirrmacher

    (Office of Health Economics)

  • Hareth Al-Janabi

    (University of Birmingham)

  • Sophie Guest

    (Roche Products Ltd)

  • Becky Pennington

    (University of Sheffield)

  • Nicolas Scheuer

    (Roche Products Ltd)

  • Koonal K. Shah

    (National Institute for Health and Care Excellence)

  • Chris Skedgel

    (Office of Health Economics)

Abstract

The provision of informal (unpaid) care can impose significant ‘spillover effects’ on carers, and accounting for these effects is consistent with the efficiency and equity objectives of health technology assessment (HTA). Inclusion of these effects in health economic models, particularly carer health-related quality of life (QOL), can have a substantial impact on net quality-adjusted life year (QALY) gains and the relative cost effectiveness of new technologies. Typically, consideration of spillover effects improves the value of a technology, but in some circumstances, consideration of spillover effects can lead to situations whereby life-extending treatments for patients may be considered cost ineffective due to their impact on carer QOL. In this piece we revisit the classic ‘QALY trap’ and introduce an analogous ‘carer QALY trap’ which may have practical implications for economic evaluations where the inclusion of carer QOL reduces incremental QALY gains. Such results may align with a strict QALY-maximisation rule, however we consider the extent to which this principle may be at odds with the preferences of carers themselves (and possibly society more broadly), potentially leading decision makers into the carer QALY trap as a result. We subsequently reflect on potential solutions, highlighting the important (albeit limited) role that deliberation has to play in HTA.

Suggested Citation

  • David J. Mott & Hannah Schirrmacher & Hareth Al-Janabi & Sophie Guest & Becky Pennington & Nicolas Scheuer & Koonal K. Shah & Chris Skedgel, 2023. "Modelling Spillover Effects on Informal Carers: The Carer QALY Trap," PharmacoEconomics, Springer, vol. 41(12), pages 1557-1561, December.
    • Handle: RePEc:spr:pharme:v:41:y:2023:i:12:d:10.1007_s40273-023-01316-0
    DOI: 10.1007/s40273-023-01316-0
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    References listed on IDEAS

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    1. Jonathan D. Campbell & Melanie D. Whittington & Steven D. Pearson, 2023. "An Alternative Measure of Health for Value Assessment: The Equal Value Life-Year," PharmacoEconomics, Springer, vol. 41(10), pages 1175-1182, October.
    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. Erik Nord & Jose Luis Pinto & Jeff Richardson & Paul Menzel & Peter Ubel, 1999. "Incorporating societal concerns for fairness in numerical valuations of health programmes," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 25-39, February.
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    Cited by:

    1. J. Mick Tilford & Aygul Tarlan, 2023. "The Carer QALY Trap and Altruism in Economic Evaluations," PharmacoEconomics, Springer, vol. 41(12), pages 1553-1555, December.

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