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. 2016 Feb;36(2):176-86.
doi: 10.1177/0272989X15605094. Epub 2015 Sep 16.

A Framework for Including Family Health Spillovers in Economic Evaluation

Hareth Al-Janabi  1 , Job van Exel  2 , Werner Brouwer  2 , Joanna Coast  1
Affiliations

A Framework for Including Family Health Spillovers in Economic Evaluation

Hareth Al-Janabi et al. Med Decis Making. 2016 Feb.

Abstract

Health care interventions may affect the health of patients' family networks. It has been suggested that these "health spillovers" should be included in economic evaluation, but there is not a systematic method for doing this. In this article, we develop a framework for including health spillovers in economic evaluation. We focus on extra-welfarist economic evaluations where the objective is to maximize health benefits from a health care budget (the "health care perspective"). Our framework involves adapting the conventional cost-effectiveness decision rule to include 2 multiplier effects to internalize the spillover effects. These multiplier effects express the ratio of total health effects (for patients and their family networks) to patient health effects. One multiplier effect is specified for health benefit generated from providing a new intervention, one for health benefit displaced by funding this intervention. We show that using multiplier effects to internalize health spillovers could change the optimal funding decisions and generate additional health benefits to society.

Keywords: economic evaluation; extra-welfarism; family; informal care; spillovers.

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Figures

Figure 1
Figure 1
Health benefits to society and health benefits to patients are maximized at the same point (Q1) when spillovers are constant across a new intervention and displaced health care. MHBP, marginal health benefits to patients; MHBS, marginal health benefits to society; MHLP, marginal health losses to patients; MHLS, marginal health losses to society.
Figure 2
Figure 2
When spillovers on a new intervention are “large,” health benefits to society are maximized at a higher quantity (Q3) than when patient health alone is considered (Q1). Triangle A represents the additional health benefit to society from increasing the quantity of the intervention from Q1 to Q3.
Figure 3
Figure 3
When spillovers on a new intervention are “small,” health benefits to society are maximized at a lower quantity (Q4) than when patient health alone is considered (Q1). Triangle B represents the health benefit to society from reducing the quantity of the intervention from Q1 to Q4. Triangle C represents the net health benefit to society generated at Q4.
Figure 4
Figure 4
Mean implied health losses (on EQ-5D-5L scale) from after-effects of meningitis incurred by patients and their carers.
See this image and copyright information in PMC

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