Center for Medical Technology Assessment (CMT), Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Appl Health Econ Health Policy. 2010;8(1):25-35. doi: 10.1007/BF03256163.
It is important for economic evaluations in healthcare to cover all relevant information. However, many existing evaluations fall short of this goal, as they fail to include all the costs and effects for the relatives of a disabled or sick individual. The objective of this study was to analyse how relatives' costs and effects could be measured, valued and incorporated into a cost-effectiveness analysis. In this article, we discuss the theories underlying cost-effectiveness analyses in the healthcare arena; the general conclusion is that it is hard to find theoretical arguments for excluding relatives' costs and effects if a societal perspective is used. We argue that the cost of informal care should be calculated according to the opportunity cost method. To capture relatives' effects, we construct a new term, the R-QALY weight, which is defined as the effect on relatives' QALY weight of being related to a disabled or sick individual. We examine methods for measuring, valuing and incorporating the R-QALY weights. One suggested method is to estimate R-QALYs and incorporate them together with the patient's QALY in the analysis. However, there is no well established method as yet that can create R-QALY weights. One difficulty with measuring R-QALY weights using existing instruments is that these instruments are rarely focused on relative-related aspects. Even if generic quality-of-life instruments do cover some aspects relevant to relatives and caregivers, they may miss important aspects and potential altruistic preferences. A further development and validation of the existing caregiving instruments used for eliciting utility weights would therefore be beneficial for this area, as would further studies on the use of time trade-off or Standard Gamble methods for valuing R-QALY weights. Another potential method is to use the contingent valuation method to find a monetary value for all the relatives' costs and effects. Because cost-effectiveness analyses are used for decision making, and this is often achieved by comparing different cost-effectiveness ratios, we argue that it is important to find ways of incorporating all relatives' costs and effects into the analysis. This may not be necessary for every analysis of every intervention, but for treatments where relatives' costs and effects are substantial there may be some associated influence on the cost-effectiveness ratio.
在医疗保健领域的经济评估中，涵盖所有相关信息非常重要。然而，许多现有的评估都未能达到这一目标，因为它们未能包括残疾或患病个体的亲属的所有成本和效果。本研究的目的是分析如何衡量、评估和将亲属的成本和效果纳入成本效益分析。在本文中，我们讨论了医疗保健领域成本效益分析的理论基础；总的结论是，如果采用社会视角，很难找到排除亲属成本和效果的理论依据。我们认为，应该根据机会成本法来计算非正式护理的成本。为了捕捉亲属的效果，我们构建了一个新术语，即 R-QALY 权重，定义为与残疾或患病个体有关的亲属的 QALY 权重的影响。我们研究了衡量、评估和纳入 R-QALY 权重的方法。一种建议的方法是估计 R-QALYs 并将其与患者的 QALY 一起纳入分析。但是，目前还没有一种完善的方法可以创建 R-QALY 权重。使用现有工具测量 R-QALY 权重的一个困难是，这些工具很少关注相对相关的方面。即使通用的生活质量工具确实涵盖了一些与亲属和护理人员相关的方面，它们也可能会错过重要的方面和潜在的利他偏好。因此，进一步开发和验证用于得出效用权重的现有护理工具将有助于这一领域，进一步研究使用时间权衡或标准博弈方法来评估 R-QALY 权重也将有所帮助。另一种潜在的方法是使用条件价值评估法为所有亲属的成本和效果找到货币价值。由于成本效益分析用于决策，而这通常是通过比较不同的成本效益比来实现的，因此我们认为，将所有亲属的成本和效果纳入分析非常重要。这可能不是对每一项干预措施的每一次分析都必要的，但对于亲属的成本和效果很大的治疗方法，可能会对成本效益比产生一些影响。
