Family Spillover Effects in Pediatric Cost-Utility Analyses
Childhood illness can impose significant costs and health strains on family members, but these are not routinely captured by pediatric economic evaluations. This review investigated how family “spillover effects” related to costs and health outcomes are considered in pediatric cost-utility analyses (CUAs).
We reviewed pediatric CUAs published between 2000 and 2015 using the Tufts Medical Center Cost-effectiveness Analysis (CEA) Registry and the Pediatric Economic Database Evaluation (PEDE) Registry. We selected studies conducted from the societal perspective and included in both registries. We investigated how frequently family spillover was incorporated into analyses, and how the inclusion of spillover health effects and costs changed CUA results.
We found 142 pediatric CUAs meeting inclusion criteria. Of those, 105 (72%) considered either family spillover costs (n = 98 time costs, n = 33 out-of-pocket costs, n = 2 caregiver healthcare costs) or health outcomes (n = 15). Twenty-four studies included 43 pairs of incremental cost-effectiveness ratios (ICERs) with and without spillover. In 19 pairs of ICERs, adding spillover changed the ICER enough to cross a common cost-effectiveness threshold (i.e., $50,000/QALY, $100,000/QALY, $150,000/QALY; values are in 2016 US$). Incorporating spillover generally made interventions more cost-effective (n = 18; 42%), or did not change CUA results enough to cross a threshold (n = 24; 56%). Including family spillover reduced ICERs by 31% ($40,000/QALY) on average.
Most pediatric CUAs conducted from a societal perspective include family costs but fewer include family health effects. Inclusion of family spillover effects tends to make CUA results more favorable. Future pediatric CUAs should aim to more fully incorporate the family burden of illness.
We would like to acknowledge Ashley Leech, PhD for her comments during the literature review process, and Peter Neumann, ScD for his comments on the manuscript.
Study concept and design: Lavelle, Lin, D’Cruz, Prosser, Ungar, Mohit, Vera-Llonch; data acquisition: Tsiplova, Lin, D’Cruz, and Lavelle; drafting publication: Lavelle, Lin, D’Cruz; all authors participated in analysis or interpretation of data as well as preparation and critical revision of the manuscript.
Compliance with Ethical Standards
This study was supported by research funding from Shire Pharmaceuticals to Tufts Medical Center.
Conflict of interest
Montserrat Vera-Llonch is an employee of Shire and owns stock/options. Tara Lavelle, Brittany D’Cruz, and Pei-Jung Lin were funded by a grant from Shire during this work. Wendy Ungar reports receiving a consulting fee from Tufts Medical Center for her contribution to this work. Babak Mohit reports receiving funds from Bayer to support his post-doctoral fellowship. Pei-Jung Lin reports personal fees from Avanir and Otsuka, outside of the scope of this work. Lisa Prosser and Kate Tsiplova report no conflicts of interest.
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