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Modelling Spillover Effects on Informal Carers: The Carer QALY Trap.

David J Mott1, Hannah Schirrmacher2, Hareth Al-Janabi3

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Informal caregiving has spillover effects on carer quality of life (QOL). Health economic models must account for carer QOL to avoid the

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Area of Science:

  • Health Economics
  • Health Technology Assessment (HTA)
  • Patient-Reported Outcomes

Background:

  • Informal caregiving significantly impacts carer well-being, creating 'spillover effects'.
  • Health economic models often overlook these carer effects, potentially misrepresenting technology value.
  • Accounting for carer health-related quality of life (QOL) is crucial for efficiency and equity in HTA.

Purpose of the Study:

  • To analyze the impact of carer QOL on health economic evaluations.
  • To introduce and explore the 'carer QALY trap' in the context of HTA.
  • To discuss potential solutions and the role of deliberation in addressing this issue.

Main Methods:

  • Revisiting the classic 'QALY trap' concept.
  • Developing an analogous 'carer QALY trap' framework.
  • Analyzing economic evaluations incorporating carer QOL.

Main Results:

  • Inclusion of carer QOL can substantially alter net quality-adjusted life-year (QALY) gains and cost-effectiveness.
  • Carer QOL considerations may lead to life-extending treatments being deemed cost-ineffective.
  • The 'carer QALY trap' may arise when including carer QOL reduces incremental QALY gains.

Conclusions:

  • Strict QALY maximization may conflict with carer and societal preferences.
  • Decision-makers may fall into the 'carer QALY trap' if carer QOL is not appropriately considered.
  • Deliberation plays a role in navigating these complexities within HTA.