European Center of Pharmaceutical Medicine, University of Basel,Basel,Switzerland.
Health Economics Unit,University of Birmingham,Birmingham,United Kingdom.
Int J Technol Assess Health Care. 2019 Jan;35(3):212-220. doi: 10.1017/S026646231900028X. Epub 2019 May 8.
It is important to capture all health effects of interventions in cost-utility analyses conducted under a societal or healthcare perspective. However, this is rarely done. Household spillovers (health effects on patients' other household members) may be particularly likely in the context of technologies and interventions to change behaviors that are interdependent in the household. Our objective was to prospectively collect outcome data from household members and illustrate how these can be included in a cost-utility analysis of a behavior change intervention in chronic obstructive pulmonary disease (COPD).
Data were collected from patients' household members (n = 153) alongside a randomized controlled trial of a COPD self-management intervention. The impact of the intervention on household members' EQ-5D-5L scores (primary outcome), was evaluated. Analyses were then carried out to estimate household members' quality-adjusted life-years (QALYs) and assess the impact of including these QALYs on cost-effectiveness.
The intervention had a negligible spillover on household members' EQ-5D-5L scores (-0.007; p = .75). There were also no statistically significant spillovers at the 5 percent level in household member secondary outcomes. In the base-case model, the inclusion of household member QALYs in the incremental cost-effectiveness ratio (ICER) denominator marginally increased the ICER from GBP 10,271 (EUR 13,146) to GBP 10,991 (EUR 14,068) per QALY gained.
This study demonstrates it is feasible to prospectively collect and include household members' outcome data in cost utility analysis, although the study highlighted several methodological issues. In this case, the intervention did not impact significantly on household members' health or health behaviors, but inclusion of household spillovers may make a difference in other contexts.
在从社会或医疗保健角度进行的成本效用分析中，捕捉干预措施的所有健康效果非常重要。然而，这种情况很少发生。在改变家庭中相互依存的行为的技术和干预措施的背景下，家庭溢出（对患者其他家庭成员的健康影响）可能特别有可能。我们的目的是从家庭成员那里前瞻性地收集结果数据，并说明如何将这些数据纳入慢性阻塞性肺疾病（COPD）行为改变干预措施的成本效用分析中。
在一项 COPD 自我管理干预的随机对照试验中，从患者的家庭成员那里收集数据（n=153）。评估干预对家庭成员 EQ-5D-5L 评分（主要结局）的影响。然后进行分析，以估计家庭成员的质量调整生命年（QALYs），并评估包括这些 QALYs 对成本效益的影响。
干预对家庭成员的 EQ-5D-5L 评分几乎没有溢出（-0.007；p=.75）。在家庭成员的次要结局中，也没有统计学意义的 5%水平的溢出。在基本模型中，将家庭成员的 QALYs 纳入增量成本效果比（ICER）分母，使增量成本效果比从 GBP 10,271（EUR 13,146）略有增加到 GBP 10,991（EUR 14,068）每获得一个 QALY。
本研究表明，前瞻性地收集和纳入家庭成员的结果数据进行成本效用分析是可行的，尽管该研究强调了几个方法学问题。在这种情况下，干预措施对家庭成员的健康或健康行为没有显著影响，但纳入家庭溢出可能在其他情况下有所不同。
