Recommendations Issued for Inclusion of Family Spillover Effects in CEA

Eve Wittenberg headshot in top left corner, Ed Henry headshot in bottom right corner, against abstract background

CHDS faculty Eve Wittenberg co-chaired an international task force developing recommendations for the inclusion of caregiver and family member impacts in the economic evaluation of healthcare interventions; guidelines were recently published in PharmacoEconomics. University of Galway, Ireland, doctoral student Edward Henry led the effort, with co-Chairs John Cullinan, Henry’s advisor at Galway, and Hareth Al-Janabi of the University of Birmingham.

It has been widely documented that an individual’s illness can have important consequences for the health and well-being of their caregivers and wider family network, yet omission of these caregiver and family health spillovers from health economic evaluation remains common practice. The Spillovers in Health Economic Evaluation and Research (SHEER) task force employed a modified nominal group technique to reach consensus on a set of recommendations for emerging good practice supporting the incorporation of health spillovers into analyses conducted from a healthcare/health payer perspective, and more generally inclusive perspectives such as a societal perspective. Recommendations include: where possible, spillovers related to displaced/foregone activities should be considered, as should the distributional consequences of inclusion; time horizons ought to be sufficient to capture all relevant impacts; the collection of primary spillover data is preferred, and clear justification should be provided when using secondary data; transparency and consistency when reporting on the incorporation of health spillovers are crucial. In addition, given that the evidence base relating to health spillovers remains limited and requires much development, 12 avenues for future research were proposed.

The prevalence of family and caregiver health spillovers is likely to rise as levels of dependency and comorbidity increase, family compositions change, health institutions shift care to the community and households, and new healthcare technologies prolong life. Consequently, the importance of the consistent consideration of spillovers in health economic evaluation will continue to grow. The taskforce hopes that their consensus recommendations will inform these incorporation efforts in taking account of health spillovers in a fair and judicious manner.

Learn more: Read the report in PharmacoEconomics
Learn more: Read about family well-being research at CHDS

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