The National Institute for Health and Care Excellence (NICE) states that economic evaluations should include direct health effects for all individuals, including carers, where relevant, yet the inclusion of carer health outcomes in NICE technology appraisals and highly specialized technologies is relatively uncommon.
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The studies used to estimate carer health outcomes in NICE appraisals used various utility measures, some used non-UK populations, some were from other disease areas or populations, and some required comparison to general population utilities.
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In the absence of clear guidance from health technology assessment bodies such as NICE, inclusion of carer health outcomes will be inconsistent between appraisals.
Abstract
Objectives
Health interventions for patients can have effects on their carers too. For consistency, decision makers may wish to specify whether carer outcomes should be included. One example is the National Institute for Health and Care Excellence (NICE), whose reference case specifies that economic evaluations should include direct health effects for patients and carers where relevant. We aimed to review the methods used in including carer health-related quality of life (HRQL) in NICE appraisals.
Methods
We reviewed all published technology appraisals (TAs) and highly specialized technologies (HSTs) to identify those that included carer HRQL and discussed the methods and data sources.
Results
Twelve of 414 TAs (3%) and 4 of 8 HSTs (50%) included carer HRQL in cost-utility analyses. Eight were for multiple sclerosis, the remainder were each in a unique disease area. Twelve of the 16 appraisals modeled carer HRQL as a function of the patient’s health state, 3 modeled carer HRQL as a function of the patient’s treatment, and 1 included family quality-adjusted life year (QALY) loss. They used 5 source studies: 2 compared carer EQ-5D scores with controls, 2 measured carer utility only (1 health utilities index and 1 EQ-5D), and 1 estimated family QALY loss from a child’s death. Two used disutility estimates not from the literature. Including carer HRQL increased the incremental QALYs and decreased incremental cost-effectiveness ratios in all cases.
Conclusions
The inclusion of carer HRQL in NICE appraisals is relatively uncommon and has been limited by data availability.
Keywords
appraisal
carer
cost-utility
NICE
spillover
Cited by (0)
Author Contributions:Concept and design: Pennington
Acquisition of data: Pennington
Analysis and interpretation of data: Pennington
Drafting of the manuscript: Pennington
Critical revision of the paper for important intellectual content: Pennington
Obtaining funding: Pennington
Conflict of Interest Disclosures: The author reported no conflicts of interest.
Funding/Support: This work was supported the National Institute for Health and Care Excellence Decision Support Unit grant.
Role of the Funder/Sponsor: The funder reviewed and approved the design and conduct of the study; collection, management, analysis, and interpretation of the data; and manuscript for publication. Funding for the study and approval for publication was not conditional upon the results.