Skip to main content
SpringerLink
Log in

The Inclusion of Spillover Effects in Economic Evaluations: Not an Optional Extra

  • Commentary
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Notes

  1. I use the word ‘optimization’ rather than maximization to allow weighting of health gains, for instance to favor gains at the end of life, in young people or patients in poor health states. Such weights can be seen as reflecting differential social values of health gains. I emphasize that analogous to difficulties in specifying a social welfare function, it may be difficult to specify a full ‘social health value function’.

  2. Recently, it was, for instance, used to argue against the inclusion of medical costs in gained life-years [22], apparently largely motivated by the outcomes of inclusion (in one particular case). But again, ignoring these costs is inconsistent with the aims and methods of economic evaluations as it ignores real (health) opportunity costs of these expenditures [23]. It thus makes life-prolonging interventions seem more cost effective than they actually are and relatively more cost effective than quality-of-life-improving interventions. Is that (necessarily) fair, also for those people who will receive less care as a consequence? I would argue that ignoring them is not the appropriate answer to the problem, not consistent with the overall decision goals and methods, nor fairer as a rule! Deliberative consideration of these costs and their consequences is warranted.

References

  1. Basu A, Meltzer D. Implications of spillover effects within the family for medical cost-effectiveness analysis. J Health Econ. 2005;24:751–73.

    Article  PubMed  Google Scholar 

  2. Bobinac A, Van Exel J, Rutten F, Brouwer W. Caring for and caring about: disentangling the caregiving effect and the family effect. J Health Econ. 2010;29(4):549–56.

    Article  PubMed  Google Scholar 

  3. Bobinac A, Van Exel J, Rutten F, Brouwer W. Health effects in significant others: separating family and caregiving effects. Med Decis Mak. 2011;31(2):292–8.

    Article  Google Scholar 

  4. Brouwer WBF, Tilford M, van Exel NJA. Incorporating caregiver and family effects in economic evaluations of child health. In: Ungar W, editor. Economic evaluation in child health. Oxford: Oxford Press; 2009.

    Google Scholar 

  5. Hoefman RJ, van Exel NJA, Brouwer WBF. How to include informal care in economic evaluations. Pharmacoeconomics. 2013;31(12):1105–19.

    Article  PubMed  Google Scholar 

  6. Al-Janabi H, van Exel NJA, Brouwer WBF, Trotter C, Glennie L, Hannigan L, et al. QALY losses in patients’ family networks: a study of the wider health effects of meningitis. Health Econ. 2016;25(12):1529–44.

    Article  PubMed  Google Scholar 

  7. Al Janabi H, van Exel NJA, Brouwer WBF, Coast J. A framework for including health spillovers in economic evaluation. Med Decis Mak. 2016;36(2):176–86.

    Article  Google Scholar 

  8. Boadway R, Bruce N. Welfare economics. Oxford: Basil Blackwell; 1984.

    Google Scholar 

  9. Claxton K, Paulden M, Gravelle H, Brouwer W, Culyer A. Discounting and decision-making in the economic evaluation of healthcare technologies. Health Econ. 2011;20:2–15.

    Article  PubMed  Google Scholar 

  10. Gold M, Siegel J, Russell L, Weinstein M. Cost-effectiveness in health and medicine. New York: Oxford University Press; 1996.

    Google Scholar 

  11. Grewal I, Lewis J, Flynn T, Brown J, Bond J, Coast J. Developing attributes for a generic quality of life measure for older people: preferences or capabilities? Soc Sci Med. 2006;62:1891–901.

    Article  PubMed  Google Scholar 

  12. Netten A, Burge P, Malley J, Potoglou D, Towers A, Brazier J, et al. Outcomes of social care for adults: developing a preference-weighted measure. Health Technol Assess. 2012;16(16):1–165.

    Article  CAS  PubMed  Google Scholar 

  13. Do YK, Norton EC, Steams SC, Van Houtven CH. Informal care and caregiver’s health. Health Econ. 2015;24(2):224–37.

    Article  PubMed  Google Scholar 

  14. Schulz R, Beach SR. Caregiving as a risk factor for mortality: the Caregiver Health Effects Study. JAMA. 1999;282(23):2215–9.

    Article  CAS  PubMed  Google Scholar 

  15. Hoefman RJ, van Exel NJA, Brouwer WBF. Measuring the experienced impact of informal care on carers: a construct validation study of the CarerQol instrument in a large sample of caregivers. Health Qual Life Outcomes. 2013;11:173.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wittenberg E, Ritter GA, Prosser LA. Evidence of spillover of illness among household members: EQ-5D scores from a US sample. Med Decis Mak. 2013;33(2):235–43.

    Article  Google Scholar 

  17. Wittenberg E, Prosser LA. Disutility of illness for caregivers and families: a systematic review of the literature. Pharmacoeconomics. 2013;31(6):489–500.

    Article  PubMed  PubMed Central  Google Scholar 

  18. NICE. Guide to the methods of technology appraisal. London: NICE; 2013.

    Google Scholar 

  19. Hoefman RJ, van Exel NJA, Brouwer WBF. How to include informal care in economic evaluations. Pharmacoeconomics. 2013;31(12):1105–19.

    Article  PubMed  Google Scholar 

  20. Payakachat N, Tilford JM, Brouwer WBF, van Exel NJA, Grosse SD. Measuring health and well-being effects in family caregivers of children with craniofacial malformations. Qual Life Res. 2011;20(9):1487–95.

    Article  PubMed  Google Scholar 

  21. Krol M, Papenburg J, van Exel NJA. Does including informal care in economic evaluations matter? A systematic review of inclusion and impact of informal care in cost-effectiveness studies. Pharmacoeconomics. 2015;33(2):123–35.

    Article  PubMed  Google Scholar 

  22. Grima DT, Bernard LM, Dunn ES, McFarlane PA, Mendelssohn DC. Cost-effectiveness analysis of therapies for chronic kidney disease patients on dialysis: a case for excluding dialysis costs. Pharmacoeconomics. 2012;30(11):981–9.

    Article  PubMed  Google Scholar 

  23. van Baal PHM, Meltzer D, Brouwer WBF. Pharmacoeconomic guidelines should prescribe inclusion of indirect medical costs! A response to Grima et al. Pharmacoeconomics. 2013;31(5):369–73.

    Article  PubMed  Google Scholar 

  24. Barrett A, Roques T, Small M, Smith RD. How much will Herceptin really cost? BMJ. 2006;333(7578):1118–20.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Tilford JM, Payakachat N. Progress in measuring family spillover effects for economic evaluations. Expert Rev Pharmacoecon Outcomes Res. 2015;15(2):195–8.

    Article  PubMed  Google Scholar 

  26. McCabe C. Expanding the scope of costs and benefits for economic evaluations in health: some words of caution. Pharmacoeconomics. 2018. https://doi.org/10.1007/s40273-018-0712-8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands

    Werner B. F. Brouwer

  2. Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands

    Werner B. F. Brouwer

  3. Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands

    Werner B. F. Brouwer

Authors
  1. Werner B. F. Brouwer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Werner B. F. Brouwer.

Ethics declarations

Funding

No funding was received for this commentary and rebuttal.

Conflict of interest

Werner Brouwer has no conflicts of interest other than a long-standing history of advocating the societal perspective in economic evaluations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brouwer, W.B.F. The Inclusion of Spillover Effects in Economic Evaluations: Not an Optional Extra. PharmacoEconomics 37, 451–456 (2019). https://doi.org/10.1007/s40273-018-0730-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40273-018-0730-6

Search

Navigation