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Närståendes konsekvenser: Hur kan de inkluderas i den hälsoekonomiska analysen?
Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
2008 (English)Report (Other academic)
Abstract [sv]

Denna rapport har skrivits vid Centrum för utvärdering av medicinsk teknologi (CMT) vid Linköpings Universitet. Ekonomiskt stöd har utgått från Landstinget i Östergötland med syftet att tjäna som metodstöd för den som använder och bedömer hälsoekonomiska utvärderingsstudier. Dessutom har ekonomiska medel tillhandahållits från Apoteket AB:s forskningsfond som en del i ett större projekt, vilket studerar vad som är med och inte med i en hälsoekonomisk utvärdering.

I rapporten diskuteras hur närståendes konsekvenser skulle kunna inkluderas i en hälsoekonomisk analys. Stora delar av detta område är relativt outforskat och stöter på en mängd metodproblem. Detta har gjort att det många gånger inte går att ge tydliga rekommendationer i dagsläget. Rapporten visar dock att närståendes konsekvenser kan vara av stor vikt i en hälsoekonomisk analys, och ett viktigt första steg är att dessa konsekvenser uppmärksammas. Vidare forskning kommer krävas för att säkerställa att närståendes konsekvenser kan mätas, värderas och inkluderas i analysen på ett korrekt sätt.    Rapporten vänder sig i första hand till dem som har viss erfarenhet av hälsoekonomiska utvärderingar. Den är dock skriven så att även den oinvigde ska kunna ta del av den. I det senare fallet kan den dock behöva kompletteras med litteratur som redogör för hälsoekonomiska utvärderingar i helhet. Ett stort tack till alla dem som vid seminarier eller annat tillfälle har gett värdefulla kommentarer på projektet.

Linköping, 2008-05-29

Thomas Davidson, Lars-Åke Levin

Abstract [en]

There is a need for cost-effectiveness analyses to include relatives’ consequences in order to fulfil the recommendation of having a societal perspective. Being a relative to a patient with a disease or a disablement can cause consequences, and these consequences may be separated between costs and effects. The costs are mainly caused by the need of providing informal care. The effects are caused by relatives’ affected quality of life. The cost for informal care is sometimes included in cost-effectiveness analyses, but relatives’ effects are, as far as we have seen, never included.

In this report we discuss relatives’ consequences, how they can be measured and valued, and also how they could be incorporated in the cost-effectiveness analysis. The recommended approach to calculate the cost of informal care is to value lost paid production as the salary including employment fees, and lost unpaid production to be valued as the relative’s own valuation of this leisure time. It is more difficult to give recommendations about how to measure and value relatives’ affected quality of life (and more studies about this are needed). One possible solution is to use instruments that measures relative-related quality of life. Another potential method is to study relatives’ willingness to pay for an improvement of the patient’s health.

It is important to avoid double counting in a cost-effectiveness analysis. This must therefore be acknowledged when relatives’ consequences are included. Cost of informal care may incorporate some of the effects on relatives’ quality of life. Furthermore there is a risk for double counting when both the patient’s and the relatives’ effects are included in the analysis. It is therefore of importance that these risks are considered in the choice of methods to measure and value relatives’ consequences.

An outcome measure that is often used to measure the effects of a treatment is quality-adjusted life years (QALY). One potential method to incorporate relatives’ effects in the cost-effectiveness ratio, which is discussed in this report, is to measure relatives’ effects in the new outcome R-QALY weights. These weights are defined as the change in relatives’ QALY weights caused by being a relative to a patient with a disease or disablement. When these weights are used to create QALYs, they can be summed with the patient’s QALYs and placed together in the denominator of the cost-effectiveness ratio. This method is however controversial as the denominator normally only includes the patient’s effects. An alternative of combining the patient’s QALY weight with relatives’ R-QALY weights could be to find a monetary value of the R-QALY weight and include this value together with the other costs in the analysis. Because of the difficulties of including relatives’ consequences we recommend to present the results both with and without relatives’ consequences. This would furthermore enable the analysis to be compared with other analyses.

As cost-effectiveness analyses often are used for decision making, we argue that it is of importance to find methods which enable the incorporation of all consequences of the relatives in the analysis. This field is evolving and more research is needed before further recommendations can be made.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2008. , 42 p.
Series
CMT Report, ISSN 0283-1228 (print), 1653-7556 (online) ; 2008:4
Keyword [en]
Health care costs
Keyword [sv]
Hälso- och sjukvårdsekonomi
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-44509ISRN: LIU CMT RA/0804Local ID: 76921OAI: oai:DiVA.org:liu-44509DiVA: diva2:265371
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2014-10-24Bibliographically approved

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