Academic Unit of Health Economics, University of Leeds, Leeds, LS2 9NL, UK.
Institute of Health and Society, Université Catholique de Louvain, Louvain-La-Neuve, Belgium.
Pharmacoeconomics. 2019 Apr;37(4):513-530. doi: 10.1007/s40273-018-0722-6.
This article presents alternative parental health spillover quantification methods in the context of a randomised controlled trial comparing family therapy with treatment as usual as an intervention for self-harming adolescents, and discusses the practical limitations of those methods.
The trial followed a sample of 754 participants aged 11-17 years. Health utilities are measured using answers to the EuroQoL 5 Dimensions 3 Levels (EQ-5D-3L) for the adolescent and the Health Utility Index (HUI2) for one parent at baseline, 6 and 12 months. We use regression analyses to evaluate the association between the parent's and adolescent's health utilities as part of an explanatory regression model including health-related and demographic characteristics of both the adolescent and the parent. We then measure cost-effectiveness over a 12-month period as mean incremental cost-effectiveness ratios using various spillover quantification methods. We propose an original quantification based on the use of a household welfare function along with an equivalence scale to generate a health gain within the family to be added to the adolescent's quality-adjusted life-year gain.
We find that the parent's health utility increased over the duration of the trial and is significantly and positively associated with adolescent's health utility at 6 and 12 months but not at baseline. When considering the adolescent's health gain only, the incremental cost-effectiveness ratio is £40,453 per quality-adjusted life-year. When including the health spillover to one parent, the incremental cost-effectiveness ratio estimates range from £27,167 per quality-adjusted life-year to £40,838 per quality-adjusted life-year and can be a dominated option depending on the quantification method used.
According to the health spillover quantification method considered, the incremental cost-effectiveness ratios vary from within the National Institute for Health and Care Excellence (NICE) cost-effectiveness threshold range to not being cost-effective.
本文提出了在一项比较家庭治疗与常规治疗对自残青少年干预的随机对照试验中，替代父母健康溢出量化方法，并讨论了这些方法的实际局限性。
该试验跟踪了 754 名 11-17 岁的参与者。健康效用是通过青少年在基线、6 个月和 12 个月时使用欧洲五维健康量表 3 级（EQ-5D-3L）和父母健康效用指数（HUI2）回答来测量的。我们使用回归分析来评估父母和青少年健康效用之间的关联，作为包括青少年和父母健康相关和人口统计学特征的解释回归模型的一部分。然后，我们使用各种溢出量化方法，在 12 个月内计算平均增量成本效益比来衡量成本效益。我们提出了一种基于使用家庭福利函数和等价规模的原始量化方法，以在家庭内产生健康收益，以增加青少年的质量调整生命年收益。
我们发现，父母的健康效用在试验期间增加，并且在 6 个月和 12 个月时与青少年的健康效用显著正相关，但在基线时没有。仅考虑青少年的健康收益时，增量成本效益比为每质量调整生命年 40453 英镑。当包括对一位父母的健康溢出时，增量成本效益比的估计范围从每质量调整生命年 27167 英镑到每质量调整生命年 40838 英镑，并且可以根据使用的量化方法成为一种主导选择。
根据所考虑的健康溢出量化方法，增量成本效益比在国家卫生与临床优化研究所（NICE）成本效益阈值范围内变化，或者没有成本效益。
