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Parental health spillover in cost-effectiveness analysis: evidence from self-harming adolescents in England

Tubeuf, Sandy, Saloniki, Eirini-Christina, Cottrell, David (2019) Parental health spillover in cost-effectiveness analysis: evidence from self-harming adolescents in England. PharmacoEconomics, 37 (4). pp. 513-530. ISSN 1170-7690. E-ISSN 1179-2027. (doi:10.1007/s40273-018-0722-6) (KAR id:69385)

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https://doi.org/10.1007/s40273-018-0722-6

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.

Item Type: Article
DOI/Identification number: 10.1007/s40273-018-0722-6
Subjects: H Social Sciences
Divisions: Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Personal Social Services Research Unit
Faculties > Social Sciences > School of Social Policy Sociology and Social Research > Centre for Health Services Studies
Depositing User: Eirini Saloniki
Date Deposited: 05 Oct 2018 11:10 UTC
Last Modified: 06 Feb 2020 04:18 UTC
Resource URI: https://kar.kent.ac.uk/id/eprint/69385 (The current URI for this page, for reference purposes)
Saloniki, Eirini-Christina: https://orcid.org/0000-0002-5867-2702
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