Family and Caregiver Spillover Effects in Cost-Utility Analyses of Alzheimer's Disease Interventions
Family and Caregiver Spillover Effects in Cost-Utility Analyses of Alzheimer's Disease Interventions
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DOI：
10.1007/s40273-019-00788-3
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发表时间：
2019-04-01
影响因子：
4.4
通讯作者：
Lavelle, Tara A.
中科院分区：
文献类型：
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作者：
Lin, Pei-Jung;D'Cruz, Brittany;Lavelle, Tara A.
背景与目的阿尔茨海默病或痴呆症会给家庭和其他非正式照顾者带来沉重的负担。本研究调查了在成本效用分析中纳入家庭/非正式护理人员溢出效应如何影响阿尔茨海默病/痴呆症干预措施的报告价值。方法我们使用PubMed来识别2000年1月1日至2018年3月31日发布的阿尔茨海默病或痴呆症成本效用分析。我们使用两名读者共识过程审查并提取了每个研究的信息。我们调查的频率和方法，家庭/照顾者的溢出成本和健康影响纳入成本效用分析，并研究如何将其列入可能会影响报告的增量成本效益ratios.Results的63阿尔茨海默氏病/痴呆症的成本效用分析符合纳入标准，44（70%）认为至少有一些家庭/照顾者的溢出成本或健康影响。32项研究仅纳入溢出成本，2项仅纳入溢出健康效应，10项两者均纳入。最常见的方法是将非正式护理时间成本添加到患者成本（n=36），并将非正式护理人员质量调整生命年添加到患者值（n=7）。在来自19项研究的33个增量成本效果比对的子集中，纳入溢出结果使增量成本效果比更有利（n=15; 45%）或在大多数情况下保持干预成本节约（n=13; 39%）。在少数情况下，包括溢出增加增量成本-效果比（n=2; 6%），保持干预占主导地位[更多成本/更少质量调整生命年]（n=2; 6%），或改变增量成本-效果比从占主导地位到更少成本/更少质量调整生命年（n=1; 3%）。在11个案例中（33%），将溢出效应纳入分析导致增量成本效益比降低，超过了共同的成本效益阈值，这可能对基于成本效益分析结果采取的计划或政策产生下游影响。讨论大多数阿尔茨海默病/痴呆症成本效用分析纳入了溢出成本，通常是护理人员的时间成本，但较少考虑溢出健康影响。在大约85%的分析中，包括阿尔茨海默病/痴呆症的溢出成本或健康影响降低了增量成本效益比或保持了干预成本节约。在某些情况下，如果不考虑对家庭和非正式照顾者的溢出效应，可能会低估阿尔茨海默病/痴呆症干预措施对社会的更广泛价值。
Background and objective Alzheimer's disease or dementia can impose a significant burden on family and other informal caregivers. This study investigated how the inclusion of family/informal caregiver spillover effects in a cost-utility analysis may influence the reported value of Alzheimer's disease/dementia interventions.Methods We used PubMed to identify Alzheimer's disease or dementia cost-utility analyses published from 1 January, 2000 to 31 March, 2018. We reviewed and abstracted information from each study using a two-reader consensus process. We investigated the frequency and methods in which family/caregiver spillover costs and health effects were incorporated into cost-utility analyses, and examined how their inclusion may influence the reported incremental cost-effectiveness ratios.Results Of 63 Alzheimer's disease/dementia cost-utility analyses meeting inclusion criteria, 44 (70%) considered at least some family/caregiver spillover costs or health effects. Thirty-two studies incorporated spillover costs only, two incorporated spillover health effects only, and ten incorporated both. The most common approach for accounting for spillover was adding informal caregiving time costs to patient costs (n=36) and adding informal caregiver quality-adjusted life-years to patient values (n=7). In a subset of 33 incremental cost-effectiveness ratio pairs from 19 studies, incorporating spillover outcomes made incremental cost-effectiveness ratios more favorable (n=15; 45%) or kept the intervention cost saving (n=13; 39%) in most cases. In fewer cases, including spillover increased incremental cost-effectiveness ratios (n=2; 6%), kept the intervention dominated [more costs/less quality-adjusted life-years] (n=2; 6%), or changed incremental cost-effectiveness ratio from dominated to less cost/less quality-adjusted life-years (n=1; 3%). In 11 cases (33%), adding spillover effects into analyses resulted in a lower incremental cost-effectiveness ratio that crossed a common cost-effectiveness threshold, which could have downstream implications for programs or policies that are adopted based on cost-effectiveness analysis results.Discussion Most Alzheimer's disease/dementia cost-utility analyses incorporated spillover costs, often as caregiver time costs, but considered spillover health impacts less often. In about 85% of the analyses, including Alzheimer's disease/dementia spillover cost or health effects decreased incremental cost-effectiveness ratios or kept the intervention cost saving. The broader value of an Alzheimer's disease/dementia intervention to society may in some cases be underestimated without considering these spillover effects on family and informal caregivers.