Recommendations for Emerging Good Practice and Future Research in Relation to Family and Caregiver Health Spillovers in Health Economic Evaluations: A Report of the SHEER Task Force

Abstract

Background Omission of family and caregiver health spillovers from the economic evaluation of healthcare interventions remains common practice. When reported, a high degree of methodological inconsistency in incorporating spillovers has been observed. Aim To promote emerging good practice, this paper from the Spillovers in Health Economic Evaluation and Research (SHEER) task force aims to provide guidance on the incorporation of family and caregiver health spillovers in cost-effectiveness and cost-utility analysis. SHEER also seeks to inform the basis for a spillover research agenda and future practice. Methods A modified nominal group technique was used to reach consensus on a set of recommendations, representative of the views of participating subject-matter experts. Through the structured discussions of the group, as well as on the basis of evidence identified during a review process, recommendations were proposed and voted upon, with voting being held over two rounds. Results This report describes 11 consensus recommendations for emerging good practice. SHEER advocates for the incorporation of health spillovers into analyses conducted from a healthcare/health payer perspective, and more generally inclusive perspectives such as a societal perspective. Where possible, spillovers related to displaced/foregone activities should be considered, as should the distributional consequences of inclusion. Time horizons ought to be sufficient to capture all relevant impacts. Currently, the collection of primary spillover data is preferred and clear justification should be provided when using secondary data. Transparency and consistency when reporting on the incorporation of health spillovers are crucial. In addition, given that the evidence base relating to health spillovers remains limited and requires much development, 12 avenues for future research are proposed. Conclusions Consideration of health spillovers in economic evaluations has been called for by researchers and policymakers alike. Accordingly, it is hoped that the consensus recommendations of SHEER will motivate more widespread incorporation of health spillovers into analyses. The developing nature of spillover research necessitates that this guidance be viewed as an initial roadmap, rather than a strict checklist. Moreover, there is a need for balance between consistency in approach, where valuable in a decision making context, and variation in application, to reflect differing decision maker perspectives and to support innovation. Supplementary Information The online version contains supplementary material available at 10.1007/s40273-023-01321-3.

A Systematic Review of Methods and Practice for Integrating Maternal, Fetal, and Child Health Outcomes, and Family Spillover Effects into Cost-Utility Analyses

“…For instance, inadequate folic acid intake by prospective mothers increases the risk of spina bifida in children [ 211 – 213 ], a condition that can result in a wide range of disabilities depending on the lesion’s location, often requiring extensive caregiving [ 214 , 215 ]. Caregivers of such children with disabilities, whether parents or other individuals, face various health-related problems [ 216 , 217 ], and it is recommended that caregiver costs and health consequences be included in economic evaluation from a societal perspective [ 48 , 49 , 218 ]. Studies have demonstrated that taking folic acid supplements before conception significantly reduces the risk of spina bifida [ 118 , 219 – 224 ], thereby preventing disabilities in children and eliminating the need for caregiving.…”

“…It is important to note that the total spillover QALY gains/losses for parents, family members, and others may be correlated with the size of the family and caregiving circle. Recently, an international task force was formed to provide guidance on the incorporation of family and caregiver health spillovers in cost-effectiveness and cost-utility analyses [ 218 ]. While the task force does not specifically provide recommendations for maternal-perinatal interventions, future researchers are encouraged to consult the SHEER Task Force recommendations on spillover effects when conducting CUAs for maternal-perinatal interventions.…”

Addressing the distributional consequences of spillovers in health economic evaluation: A prioritarian approach

“…While the potential for allocative justice to be jeopardised by consideration of health spillovers in economic evaluation has long been established Basu & Meltzer, 2005), recent commentaries on the normative implications of their inclusion (Brouwer, 2019;Dixon & Round, 2019;McCabe, 2019) have brought the need to investigate the possible distributional consequences of spillovers into sharp focus (Henry et al, 2023). Apart from an initial effort by Tubeuf et al (2019), who propose prioritisation of patient health via an equivalence scale-based approach, there is very little research on the extent, acceptability, or means of mitigation of the equity impacts of spillover inclusion identifiable in the literature.…”

“…Equation ( 1) highlights the differentially weighted spillovers specific to each network member, which may be of value in a decision-making context and in safeguarding transparency when including spillovers (Henry et al, 2023). It can, however, also be simplified 1 to give Equation (2), which reinforces that the total incremental spillover is independent of ranking.…”