Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
PharmacoEconomics
Published in: PharmacoEconomics 4/2019

Open Access 01-04-2019 | Original Research Article

Parental Health Spillover in Cost-Effectiveness Analysis: Evidence from Self-Harming Adolescents in England

Authors: Sandy Tubeuf, Eirini-Christina Saloniki, David Cottrell

Published in: PharmacoEconomics | Issue 4/2019

Login to get access

Abstract

Objective

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.

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.

Results

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.

Conclusion

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.
Appendix
Available only for authorised users
Footnotes
1
The study collected data on the main caregiver, who was either the mother (86%) or the father (11%), thus we loosely use the term parent in this article.
 
2
Results available upon request.
 
3
TAU included supportive therapy/counselling (25.1%), cognitive-behavioural therapy (17.4%), family work (11.5%), formal systemic FT (10.7%) and various other therapies.
 
4
Quantification 1 is based on the Tobit regression results presented in Table 5. Quantification 2 is based on the Tobit regression results presented in Table 7 of the “Appendix”. Quantification 3 is based on the Tobit regression results presented in Table 8 of the “Appendix”. Quantification 4 is based on the Tobit regression results presented in Table 9 of the “Appendix”.
 
5
See Table (p. 2) in the OECD note on ESs available here URL: http://​www.​oecd.​org/​eco/​growth/​OECD-Note-EquivalenceScale​s.​pdf (consulted June 2018).
 
Literature
1.
Evans E, Hawton K, Rodham K. In what ways are adolescents who engage in self-harm or experience thoughts of self-harm different in terms of help-seeking, communication and coping strategies? J Adolesc. 2005;28(4):573–87.CrossRefPubMed
2.
3.
Shah AJ, Wadoo O, Latoo J. Quality of life for parents of children with autism spectrum disorders. Br J Med Pract. 2010;3(3):327.
4.
McCrone P, Dhanasiri S, Patel A, Knapp M, Lawton-Smith S. Paying the price: the cost of mental health in England to 2026. London: The King’s Fund; 2008.
5.
Wittenberg E, Saada A, Posser LA. How illness affects family members: a qualitative interview survey. Patient. 2013;6:257–68.CrossRefPubMed
6.
Lavelle TA, Wittenberg E, Lamarand K, Posser LA. Variation in the spillover effects of illness on parents, spouses, and children of the chronically ill. Appl Health Econ Health Policy. 2014;12:117–24.CrossRefPubMedPubMedCentral
7.
Kuhlthau K, Payakachat N, Delahaye J, Hurson J, Pyne JM, Kovacs E, et al. Quality of life for parents of children with autism spectrum disorders. Res Autism Spectr Disord. 2014;8:1339–50.CrossRef
8.
Stratton P. Report On The Evidence Base Of Systemic Family Therapy. Association for Family Therapy, UK
9.
Fortune S, Cottrell D, Fife S. Family factors associated with adolescent self-harm: a narrative review. J Fam Ther. 2016;38(2):226–56.CrossRef
10.
Byford S, Harrington R, Torgerson D, Kerfoot M, Dyer E, Harrington V, et al. Cost-effectiveness analysis of a home-based social work intervention for children and adolescents who have deliberately poisoned themselves: results of a randomised controlled trial. Br J Psychiatry. 1999;174:56–62.CrossRefPubMed
11.
Goldfield G, Epstein L, Kilanowski C, Paluch R, Kogut-Bossler B. Cost-effectiveness of group and mixed family-based treatment for childhood obesity. Int J Obesity. 2001;25(12):1843–9.CrossRef
12.
Flores G, Bridon C, Torres S, Perez R, Walter T, Brotanek J, et al. Improving asthma outcomes in minority children: a randomized, controlled trial of parent mentors. Pediatrics. 2009;124(6):1522–32.CrossRefPubMed
13.
Bodden DH, Dirksen CD, Bogels SM, Nauta MH, De Haan E, Ringrose J, et al. Costs and cost-effectiveness of family CBT versus individual CBT in clinically anxious children. Clin Child Psychol Psychiatry. 2008;13(4):543–64.CrossRefPubMed
14.
Cottrell D, Wright-Hughes A, Collinson M, Boston P, Eisler I, Fortune S, et al. Effectiveness and cost-effectiveness of systemic family therapy compared with treatment as usual for young people after self-harm: a pragmatic randomised controlled trial. Lancet Psychiatry. 2018;5(3):203–16.CrossRefPubMedPubMedCentral
15.
Griebsch I, Coast J, Brown J. Quality-adjusted life-years lack quality in pediatric care: a critical review of published cost-utility studies in child health. Pediatrics. 2005;115(5):e600–14.CrossRefPubMed
16.
Fals-Stewart W, O’Farrell TJ, Birchler GR, Cordova J, Kelley ML. Behavioral couples therapy for alcoholism and drug abuse: where we’ve been, where we are, and where we’re going. J Cogn Psychother. 2005;19(3):229–46.CrossRef
17.
Crane D. Does family therapy reduce health care costs for more than the identified patient? Clin Child Psychol Psychiatry. 2011;16(1):3–4.CrossRefPubMed
18.
NICE. Guide to the methods of technology appraisal. Process and methods guides. London: NICE; 2013. p. 102.
19.
Wittenberg E, Posser LA. Disutility of illness for caregivers and families: a systematic review of the literature. Pharmacoeconomics. 2013;31:489–500.CrossRefPubMedPubMedCentral
20.
Meeuwsen E, Melis R, van der Aa G, Goluke-Willemse G, de Leest B, van Raak F, et al. Cost-effectiveness of one year dementia follow-up care by memory clinics or general practitioners: economic evaluation of a randomised controlled trial. PLoS One. 2013;8(11):1–7.CrossRef
21.
Søgaard R, Sørensen J, Waldorff FB, Eckermann A, Buss DV, Phung KTT, et al. Early psychosocial intervention in Alzheimer’s disease: cost utility evaluation alongside the Danish Alzheimer’s Intervention Study (DAISY). BMJ Open. 2014;4:e004105.CrossRefPubMedPubMedCentral
22.
Sturkenboom IHWM, Hendriks JCM, Graff MJL, Adang EMM, Munneke M, Nijhuis-van der Sanden MWG, et al. Economic evaluation of occupational therapy in Parkinson’s disease: a randomized controlled trial. Move Disord. 2015;30(8):1059–67.CrossRef
23.
Al-Janabi H, Exel VJ, Brouwer W, Coast J. A framework for including family health spillovers in economic evaluation. Med Decis Mak. 2016;36(2):176–86.CrossRef
24.
Al-Janabi H, Exel VJ, Brouwer W, Trotter C, Glennie L, Hannigan L, et al. Measuring health spillovers for economic evaluation: a case study in meningitis. Health Econ. 2016;25:1529–44.CrossRefPubMed
25.
Wright-Hughes A, Graham E, Farrin A, Collinson M, Boston P, Eisler I, et al. Self-Harm Intervention: Family Therapy (SHIFT), a study protocol for a randomised controlled trial of family therapy versus treatment as usual for young people seen after a second or subsequent episode of self-harm. Trials. 2015;16(1):501.CrossRefPubMedPubMedCentral
26.
Kazdin AE, Rodgers A, Colbus D. The hopelessness scale for children: psychometric characteristics and concurrent validity. J Consult Clin Psychol. 1986;54(2):241.CrossRefPubMed
27.
Wiedemann G, Rayki O, Feinstein E, Hahlweg K. The Family Questionnaire: development and validation of a new self-report scale for assessing expressed emotion. Psych Res. 2002;109(3):265–79.CrossRef
28.
Miller IW, Epstein NB, Bishop DS, Keitner GI. The McMaster family assessment device: reliability and validity. J Marital Fam Ther. 1985;11(4):345–56.CrossRef
29.
Goldberg D. General Health Questionnaire (GHQ-12). Windsor: Nfer-Nelson; 1992.
30.
EuroQoL Group. EuroQoL: a new facility for the measurement of health related quality of life. Health Policy. 1990;16:199–208.CrossRef
31.
Horsman J, Furlong W, Feeny D, Torrance G. The Health Utilities Index (HUI®): concepts, measurement properties and applications. Health Qual Life Outcomes. 2003;1(1):1.CrossRef
32.
Feeny D, Furlong W, Boyle M, Torrance GW. Multi-attribute health status classification systems: Health Utilities Index. Pharmacoeconomics. 1995;7(6):490–502.CrossRefPubMed
33.
34.
Adlard N, Kinghorn P, Frew E. Is the UK NICE “reference case” influencing the practice of pediatric quality-adjusted life-year measurement within economic evaluations? Value Health. 2014;17:454–61.CrossRefPubMed
35.
Oluboyede Y, Tubeuf S, McCabe C. Measuring health outcomes of adolescents: report from a pilot study. Eur J Health Econ. 2013;14(1):11–9.CrossRefPubMed
36.
37.
McCabe C, Stevens K, Roberts J, Brazier J. Health state values for the HUI2 descriptive system: results from a UK Survey. Health Econ. 2005;14(3):231–44.CrossRefPubMed
38.
39.
Cottrell D, Wright-Hughes A, Collinson M, Boston P, Eisler I, Fortune S, et al. A pragmatic randomised controlled trial and economic evaluation of family therapy versus treatment as usual for young people seen after second or subsequent episodes of self-harm: the Self-Harm Intervention-Family Therapy (SHIFT) trial. Health Technol Assess. 2018;22(12):1–222.CrossRefPubMedPubMedCentral
40.
Little RJ, Rubin DB. Single imputation methods. In: Little RJ, Rubin DB, editors. Statistical analysis with missing data. 2nd ed. New York: John Wiley & Sons; 2002. p. 59–74.CrossRef
41.
Rubin DB. The calculation of posterior distributions by data augmentation. Comment: A noniterative sampling/importance resampling alternative to the data augmentation algorithm for creating a few imputations when fractions of missing information are modest: the SIR algorithm. J Am Stat Assoc. 1987;82(398):543–6.
42.
Schafer JL. Analysis of incomplete multivariate data. London: CRC Press; 1997.CrossRef
43.
Bhadhuri A, Jowett S, Jolly K, Al-Janabi H. A comparison of the validity and responsiveness of the EQ-5D-5L and SF-6D for measuring health spillovers: a study of the family impact of meningitis. Med Decis Mak. 2017;37(8):882–93.CrossRef
44.
Buhmann B, Rainwater L, Guenther S, Timothy S. Equivalence scales, well-being, inequality, and poverty: sensitivity estimates across ten countries using the Luxembourg Income Study (LIS) database. Rev Income Wealth. 1988;34(2):115–42.CrossRef
45.
46.
Anyaegbu G. Using the OECD equivalence scale in taxes and benefits analysis. Econ Labour Market Rev. 2010;4:49–54.CrossRef
47.
Cuellar-Flores I, Sanchez-Lopez MP, Liminana-Gras RM, Colodro-Conde L. The GHQ-12 for the assessment of psychological distress of family caregivers. Behav Med. 2014;40(2):65–70.CrossRefPubMed
48.
Klassen A, Raina P, Reineking S, Dix D, Pritchard S, O’Donnell M. Developing a literature base to understand the caregiving experience of parents of children with cancer: a systematic review of factors related to parental health and well-being. Support Care Cancer. 2007;15:807–18.CrossRefPubMed
49.
Lindkvist M, Feldman I. Assessing outcomes for cost-utility analysis in mental health interventions: mapping mental health specific outcome measure GHQ-12 onto EQ-5D-3L. Health Qual Life Outcomes. 2016;14(134):1–9.
50.
Barton GR, Bankart J, Davis AC, Summerfield QA. Comparing utility scores before and after hearing-aid provision: results according to the EQ-5D, HUI3 and SF-6D. Appl Health Econ Health Policy. 2004;3(2):103–5.CrossRefPubMed
51.
Marra CA, Woolcott JC, Kopec JA, et al. A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D, and the EQ-5D) and disease-specific instruments (the RAQoL and the HAQ) in rheumatoid arthritis. Soc Sci Med. 2005;60(7):1571–82.CrossRefPubMed
52.
McDonough CM, Grove MR, Tosteson TD, Lurie JD, Hilibrand AS, Tosteson AN. Comparison of EQ-5D, HUI, and SF-36-derived societal health state values among spine patient outcomes research trial (SPORT) participants. Qual Life Res. 2005;14(5):1321–32.CrossRefPubMedPubMedCentral
53.
Polinder S, Haagsma JA, Bonsel G, Essink-Bot ML, Toet H, van Beeck EF. The measurement of long-term health-related quality of life after injury: comparison of EQ-5D and the health utilities index. Inj Prev. 2010;16(3):147–53.CrossRefPubMed
54.
Fals-Stewart W, Yates BT, Klostermann K. Assessing the costs, benefits, cost-benefit ratio, and cost-effectiveness of marital and family treatments: why we should and how we can. J Fam Psychol. 2005;19(1):28–39.CrossRefPubMed
55.
Labelle RJ, Hurley JE. Implications of basing health-care resources allocations on cost-utility analysis in the presence of externalities. J Health Econ. 1992;11:259–77.CrossRefPubMed
56.
Ng ESW, Grieve R, Carpenter JR. Two-stage nonparametric bootstrap sampling with shrinkage correction for clustered data. Stata J. 2013;13(1):141–64.CrossRef
Metadata
Title
Parental Health Spillover in Cost-Effectiveness Analysis: Evidence from Self-Harming Adolescents in England
Authors
Sandy Tubeuf
Eirini-Christina Saloniki
David Cottrell
Publication date
01-04-2019
Publisher
Springer International Publishing
Published in
PharmacoEconomics / Issue 4/2019
Print ISSN: 1170-7690
Electronic ISSN: 1179-2027
DOI
https://doi.org/10.1007/s40273-018-0722-6

Other articles of this Issue 4/2019

PharmacoEconomics 4/2019 Go to the issue

Systematic Review

Spillover Effects on Caregivers’ and Family Members’ Utility: A Systematic Review of the Literature

Commentary

The Inclusion of Spillover Effects in Economic Evaluations: Not an Optional Extra

Original Research Article

An Examination of Downstream Effects of Bereavement on Healthcare Utilization for Surviving Spouses in a National Sample of Older Adults

Original Research Article

Family and Caregiver Spillover Effects in Cost-Utility Analyses of Alzheimer’s Disease Interventions

Original Research Article

Measuring Health Spillover Effects in Caregivers of Children with Autism Spectrum Disorder: A Comparison of the EQ-5D-3L and SF-6D

Review Article

Quantifying Family Spillover Effects in Economic Evaluations: Measurement and Valuation of Informal Care Time