Aim: The aim of this paper is to demonstrate how the choice of patient versus proxy ratings of patient health-related quality of life (HRQoL) in dementia, for use in cost-effectiveness analyses (CEAs), could potentially affect resource allocation in health care.
Method: Using a model of Alzheimer’s disease (AD) based on cognitive ability, we assessed the consequences of using HRQoL ratings from either patients themselves or proxies if a new treatment was to be introduced. The model was based on previously published data on costs related to AD stages as well as HRQoL ratings from AD patients and from their caregivers as proxy raters.
Results: The results of the present study show that there can be large differences in the results of the CEAs depending on whether the ratings of patient HRQoL were made by the patient themselves or by the caregiver proxy. When atient self-ratings of HRQoL were used, the cost/quality-adjusted life year (QALY) gained was much higher as compared to the scenario when caregiver proxy ratings were used for the same analysis. These differences in results may have an impact on resource allocation.
Conclusion: In the present study, we show that the choice of patient self-ratings compared to proxy ratings of patients’ HRQoL can have a substantial effect on the results of CEAs and that these differences in results may have an important impact on decision making and, ultimately, resource allocation. In order to critically appraise the results of CEA studies in dementia and to decide on methodology, it is of great importance that focus should be directed towards determining the most valid way to measure HRQoL in AD.