Abstract
Background
Omission of family and caregiver health spillovers from the economic evaluation of healthcare interventions remains common practice. When reported, a high degree of methodological inconsistency in incorporating spillovers has been observed.
Aim
To promote emerging good practice, this paper from the Spillovers in Health Economic Evaluation and Research (SHEER) task force aims to provide guidance on the incorporation of family and caregiver health spillovers in cost-effectiveness and cost-utility analysis. SHEER also seeks to inform the basis for a spillover research agenda and future practice.
Methods
A modified nominal group technique was used to reach consensus on a set of recommendations, representative of the views of participating subject-matter experts. Through the structured discussions of the group, as well as on the basis of evidence identified during a review process, recommendations were proposed and voted upon, with voting being held over two rounds.
Results
This report describes 11 consensus recommendations for emerging good practice. SHEER advocates for the incorporation of health spillovers into analyses conducted from a healthcare/health payer perspective, and more generally inclusive perspectives such as a societal perspective. 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. Currently, 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 are proposed.
Conclusions
Consideration of health spillovers in economic evaluations has been called for by researchers and policymakers alike. Accordingly, it is hoped that the consensus recommendations of SHEER will motivate more widespread incorporation of health spillovers into analyses. The developing nature of spillover research necessitates that this guidance be viewed as an initial roadmap, rather than a strict checklist. Moreover, there is a need for balance between consistency in approach, where valuable in a decision making context, and variation in application, to reflect differing decision maker perspectives and to support innovation.
Omission of family and caregiver health spillovers from the economic evaluation of healthcare interventions remains common practice. When reported, a high degree of methodological inconsistency in incorporating spillovers has been observed.
Aim
To promote emerging good practice, this paper from the Spillovers in Health Economic Evaluation and Research (SHEER) task force aims to provide guidance on the incorporation of family and caregiver health spillovers in cost-effectiveness and cost-utility analysis. SHEER also seeks to inform the basis for a spillover research agenda and future practice.
Methods
A modified nominal group technique was used to reach consensus on a set of recommendations, representative of the views of participating subject-matter experts. Through the structured discussions of the group, as well as on the basis of evidence identified during a review process, recommendations were proposed and voted upon, with voting being held over two rounds.
Results
This report describes 11 consensus recommendations for emerging good practice. SHEER advocates for the incorporation of health spillovers into analyses conducted from a healthcare/health payer perspective, and more generally inclusive perspectives such as a societal perspective. 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. Currently, 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 are proposed.
Conclusions
Consideration of health spillovers in economic evaluations has been called for by researchers and policymakers alike. Accordingly, it is hoped that the consensus recommendations of SHEER will motivate more widespread incorporation of health spillovers into analyses. The developing nature of spillover research necessitates that this guidance be viewed as an initial roadmap, rather than a strict checklist. Moreover, there is a need for balance between consistency in approach, where valuable in a decision making context, and variation in application, to reflect differing decision maker perspectives and to support innovation.
| Original language | English |
|---|---|
| Number of pages | 20 |
| Journal | PharmacoEconomics |
| Early online date | 2 Dec 2023 |
| DOIs | |
| Publication status | E-pub ahead of print - 2 Dec 2023 |
Bibliographical note
AcknowledgementsThe authors are deeply appreciative of valuable comments on earlier drafts of this report provided by internal reviewers Anirban Basu and Paula Lorgelly. Likewise, the contributions of the following patient and caregiver representatives are very much appreciated: Elaine Houlihan, Lette Moloney, Michelle O’Neill and Claudia Rathje. We also thank Dawn Lee and audience members for their discussion of a preliminary report of this task force at the Health Economists’ Study Group Winter 2023 Meeting in Manchester, as well as seminar participants at the Discipline of Economics, University of Galway, at the Center for Health Decision Science, Harvard T.H. Chan School of Public Health, and at the Center for the Evaluation of Value and Risk in Health at the Institute for Clinical Research and Health Policy Studies, Tufts Medical Center. Session participants at the 7th EuroQol Academy 2023 and attendees at the 18th Biennial European Conference of the Society for Medical Decision Making, and three anonymous reviewers are thanked for their feedback. We are grateful to Joanna Coast for her input. We also thank Family Carers Ireland, the Health Service Executive Integrated Care Programme for Prevention and Management of Chronic Disease, Croí – The West of Ireland Cardiac and Stroke Foundation, and Martha Killilea of the PPI Ignite Network @ University of Galway for their assistance, advice and support. Wendy J. Ungar (https://orcid.org/0000-0002-0762-0101) is supported by the Canada Research Chair in Economic Evaluation and Technology Assessment in Child Health.