Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jan;35(1):81-93.
doi: 10.1177/0272989X14541328. Epub 2014 Jul 23.

Measuring family HRQoL spillover effects using direct health utility assessment

Lisa A Prosser  1   2 , Kara Lamarand  1 , Acham Gebremariam  1 , Eve Wittenberg  3
Affiliations
Free PMC article

Measuring family HRQoL spillover effects using direct health utility assessment

Lisa A Prosser et al. Med Decis Making. 2015 Jan.
Free PMC article

Abstract

Background: Applications of cost-effectiveness analysis do not typically incorporate effects on caregiver quality of life despite increasing evidence that these effects are measurable.

Methods: Using a national sample of US adults, we conducted 2 cross-sectional surveys during December 2011 and January 2012. One version asked respondents to value their own experience as the family member of a person with a chronic illness (experienced sample), and the other version asked respondents to value hypothetical scenarios describing the experience of having a family member with a chronic illness (community sample). Conditions included Alzheimer's disease/dementia, arthritis, cancer, and depression. Using standard gamble questions, respondents were asked to value the spillover effects of a family member's illness. We used regression analysis to evaluate the disutility (loss in health-related quality of life) of having a family member with a chronic illness by condition and relationship type, controlling for the respondent's own conditions and sociodemographic characteristics.

Results: For the experienced sample (n = 1389), regression analyses suggested that greater spillover was associated with certain conditions (arthritis, depression) compared with other conditions (Alzheimer's disease, cancer). For the community sample (n = 1205), regression analyses indicated that lower spillover was associated with condition (cancer) but not the type of relationship with the ill family member (parent, child, spouse).

Conclusions: The effects of illness extend beyond the individual patient to include effects on caregivers of patients, parents of ill children, spouses, and other close family and household members. Cost-effectiveness analyses should consider the inclusion of health-related quality of life spillover effects in addition to caregiving time costs incurred by family members of ill individuals.

Keywords: caregivers; cost-effectiveness analysis; family; health utility; health-related quality of life.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Experimental design by age, relationship, and condition. *Respondents in the community sample were asked to value two hypothetical health states provided to them, resulting in 1872 observations.
Figure 2
Figure 2
Standard gamble questions.
Figure 3
Figure 3
Adjusted standard gamble disutilities by version, condition, and sample (simulated).
See this image and copyright information in PMC

References

    1. Brouwer WBF. Too important to ignore: informal caregivers and other significant others. PharmacoEconomics. 2006;24(1):39–41. - PubMed
    1. Bobinac A, van Exel NJ, Rutten FF, Brouwer WB. Health effects in significant others: separating family and care-giving effects. Med Decis Making. 2011;31(2):292–8. - PubMed
    1. Wittenberg E, Saada A, Prosser LA. How illness affects family members: domains of well-being affected by “spillover.” Conference Proceedings for the 34th Annual Meeting of the Society for Medical Decision Making; 2012 October 17–20; Phoenix, AZ.
    1. Gold MR, Siegel JE, Russell LB, Weinstein MC, eds. Cost-Effectiveness in Health and Medicine. New York: Oxford University Press; 1996.
    1. Wittenberg E, Prosser LA. Disutility of illness for caregivers and families: a systematic review of the literature. PharmacoEconomics. 2013;31(6):489–500. - PMC - PubMed

Publication types