School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.
Value Health. 2022 Sep;25(9):1644-1653. doi: 10.1016/j.jval.2022.02.008. Epub 2022 Mar 24.
Health interventions for patients can also affect the health of their informal carers and family members. These changes in carer or family member health could be reflected in cost-utility analyses (CUAs) through the inclusion of their quality-adjusted life-years (QALYs). We conducted a systematic review to identify and describe all CUAs that have included family member health-related QALYs.
A total of 4 bibliographic databases were searched from inception to July 2021. A 2-stage sifting process for inclusion of studies was undertaken. We performed data extraction using a standardized data extraction form and performed a narrative synthesis of the evidence.
A total of 40 CUAs published between 1999 and 2021 were identified. CUAs were conducted in 15 different countries. CUAs examined 13 different conditions including 15 CUAs on vaccination, 5 on Alzheimer's disease, 2 on Parkinson's disease, 3 on dementia, and 2 on terminal illness. The EQ-5D was the most commonly used measure of family member health. Generally, including carer QALYs resulted in lower incremental cost-effectiveness ratios.
When considering the total number of economic evaluations published, few have included family member QALYs and the methods for doing so are often inconsistent and data sources often limited. Estimation of family member QALYs in patient CUAs was regularly uncertain and often substantial in magnitude. The findings highlight the variation among methods and call for greater consistency in methods for incorporating family member QALYs in patient CUAs.
患者的健康干预措施也会影响其非正式照顾者和家庭成员的健康。这些照顾者或家庭成员健康状况的变化可以通过纳入他们的质量调整生命年（QALY）来反映在成本效用分析（CUA）中。我们进行了一项系统评价，以确定和描述所有纳入了家庭成员健康相关 QALY 的 CUA。
从开始到 2021 年 7 月，共搜索了 4 个文献数据库。进行了 2 阶段的研究筛选过程。我们使用标准化的数据提取表格提取数据，并对证据进行叙述性综合。
共确定了 1999 年至 2021 年间发表的 40 项 CUA。CUA 是在 15 个不同的国家进行的。CUA 研究了 13 种不同的疾病，包括 15 项疫苗接种 CUA、5 项阿尔茨海默病 CUA、2 项帕金森病 CUA、3 项痴呆症 CUA 和 2 项终末期疾病 CUA。EQ-5D 是最常用于衡量家庭成员健康的测量工具。通常，包括照顾者的 QALY 会导致更低的增量成本效益比。
考虑到已发表的经济评估总数，很少有包括家庭成员 QALY 的评估，而且这些评估的方法往往不一致，数据来源也往往有限。在患者 CUA 中估算家庭成员的 QALY 通常是不确定的，而且往往具有很大的不确定性。这些发现突出了方法之间的差异，并呼吁在患者 CUA 中纳入家庭成员 QALY 的方法更加一致。
