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Incorporating Household Spillovers in Cost Utility Analysis: A Case Study Using Behavior Change in COPD
Arjun Bhadhuri1, Hareth Al-Janabi2, Sue Jowett2
1European Center of Pharmaceutical Medicine, University of Basel,Basel,Switzerland.
Summary
This study found that including household members' health outcomes in cost-utility analyses is feasible but did not significantly impact the cost-effectiveness of a COPD self-management intervention. The analysis showed minimal effect on household members' quality-adjusted life-years (QALYs).
Area of Science:
- Health Economics
- Public Health
- Behavioral Science
Background:
- Cost-utility analyses (CUAs) often omit health effects on household members (spillovers).
- Behavior change interventions, especially in chronic conditions like COPD, may influence household dynamics and member health.
- Capturing these spillovers is crucial for comprehensive societal perspective analyses.
Purpose of the Study:
- To prospectively collect outcome data from household members of COPD patients.
- To assess the impact of a COPD self-management intervention on household members' health-related quality of life.
- To evaluate the feasibility and effect of including household member quality-adjusted life-years (QALYs) in a cost-utility analysis.
Main Methods:
- Prospective data collection from 153 household members alongside a COPD self-management intervention RCT.
- Evaluation of household members' EQ-5D-5L scores and secondary outcomes.
- Calculation of household member QALYs and assessment of their impact on the incremental cost-effectiveness ratio (ICER).
Main Results:
- The COPD intervention showed negligible impact on household members' EQ-5D-5L scores (p = .75).
- No statistically significant health spillovers were observed in secondary outcomes for household members.
- Including household member QALYs marginally increased the ICER from GBP 10,271 to GBP 10,991 per QALY gained.
Conclusions:
- Prospectively collecting household member outcome data for CUAs is feasible, though methodological challenges exist.
- In this specific COPD intervention, household spillovers did not significantly alter cost-effectiveness.
- Inclusion of household spillovers may be more impactful for different interventions or patient populations.
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