Abstract
Objectives
While health technologies are targeted at improving patient health-related quality of life (HRQoL), it is increasingly acknowledged that treatments can also benefit individuals within the patient’s network, such as caring and non-caring family members. The 2022 National Institute for Health and Care Excellence (NICE) methods guide states that health effects in others, particularly carers, should be included in economic evaluations when relevant. A review of NICE appraisals by Pennington (2020) showed that in practice the consideration of carer HRQoL in cost-utility analysis (CUA) is rare. In this study, we aimed to establish the use of carer HRQoL in NICE appraisals since the Pennington review.
Methods
We have updated the review from Pennington following the approach described in the original article. Technology appraisals (TAs) and highly specialized technologies (HSTs) published between January 2019 and March 2022 were screened for the inclusion of carer HRQoL. Methods and data sources for the inclusion of carer HRQoL were extracted and analysed.
Results
In the Pennington review, 3% (12/414) of TAs and 50% (4/8) of HSTs included carer HRQoL in the CUA, this increased to 6% (13/226) of TAs and 78% (7/9) of HSTs in our update. Historically, appraisals relied on published sources for carer HRQoL estimates. Whereas in recent submissions, de-novo utility studies were more prevalent. In these studies, HRQoL was measured using EQ-5D, EQ-VAS or TTO. Carer HRQoL was most frequently modelled as function of a patient’s health state and less frequently as function of a patient’s treatment or clinical event. Whether NICE accepts the inclusion of carer HRQoL in the base-case often hinges on the perceived certainty of the input parameters.
Conclusions
The inclusion of carer HRQoL is becoming increasingly prevalent in NICE appraisals, but is still uncommon. The robustness of the evidence is pivotal for inclusion in the base-case analysis.
While health technologies are targeted at improving patient health-related quality of life (HRQoL), it is increasingly acknowledged that treatments can also benefit individuals within the patient’s network, such as caring and non-caring family members. The 2022 National Institute for Health and Care Excellence (NICE) methods guide states that health effects in others, particularly carers, should be included in economic evaluations when relevant. A review of NICE appraisals by Pennington (2020) showed that in practice the consideration of carer HRQoL in cost-utility analysis (CUA) is rare. In this study, we aimed to establish the use of carer HRQoL in NICE appraisals since the Pennington review.
Methods
We have updated the review from Pennington following the approach described in the original article. Technology appraisals (TAs) and highly specialized technologies (HSTs) published between January 2019 and March 2022 were screened for the inclusion of carer HRQoL. Methods and data sources for the inclusion of carer HRQoL were extracted and analysed.
Results
In the Pennington review, 3% (12/414) of TAs and 50% (4/8) of HSTs included carer HRQoL in the CUA, this increased to 6% (13/226) of TAs and 78% (7/9) of HSTs in our update. Historically, appraisals relied on published sources for carer HRQoL estimates. Whereas in recent submissions, de-novo utility studies were more prevalent. In these studies, HRQoL was measured using EQ-5D, EQ-VAS or TTO. Carer HRQoL was most frequently modelled as function of a patient’s health state and less frequently as function of a patient’s treatment or clinical event. Whether NICE accepts the inclusion of carer HRQoL in the base-case often hinges on the perceived certainty of the input parameters.
Conclusions
The inclusion of carer HRQoL is becoming increasingly prevalent in NICE appraisals, but is still uncommon. The robustness of the evidence is pivotal for inclusion in the base-case analysis.
| Original language | English |
|---|---|
| DOIs | |
| Publication status | Published - Dec 2022 |
| Externally published | Yes |