Measuring Family HRQOL Spillover Effects Using QALYs
Lisa A. Prosser, PhDUniversity of Michigan
CANS Special Topics ConferenceOctober 14, 2015
The authors have no conflicts to declare
Background• Guidelines for cost-effectiveness analysis
recommend inclusion of caregiver effects• Caregiver effects can include 2 components:• Time costs for informal care• Reduction in quality of life (QOL) associated with
having an ill family member
• Standard practice to include time costs but not effects on QOL (Goodrich et al., 2012)
Outline
• Brief review of spillover• Measuring spillover using QALYs• Future research topics
Household Decision Making Model
Child
Parents Grandparents
TeachersSiblings
Household Decision Making Model
Child
Parents Grandparents
TeachersSiblings
Measuring Family HRQOL Spillover Using Direct
ElicitationCo-Authors:• Eve Wittenberg, PhD, MPP, Harvard School of Public Health• Kara Lamarand, MPH, University of Michigan• Achamyeleh Gebremariam, MS, University of Michigan
Funding Source:• National Institute of Nursing Research (5R01NR011880)
Source: Prosser et al. Med Decis Making. 2015;35(1):81-93
Objectives• To measure the spillover effects on health-related
quality of life (disutility) of having a family member with a chronic illness using direct health utility assessment methods
• To assess whether spillover varies with condition or relationship type
Methods• National online survey of adults and adolescents:• Experienced sample (ill family member), n= 1389• Community sample (hypothetical scenarios), n=
1205
• Qualitative follow-up interviews, n=49• Conditions: Alzheimer’s disease, Arthritis, Cancer,
Cerebral Palsy, Depression• Ill family member: Child, Spouse, Parent• Spillover valuation approach: Direct elicitation
questions (standard gamble, rating scale)
Question Frames
YOU
Frame 1 Frame 2
YOU SPOUSE
Frame 3
YOU SPOUSE
Sample Valuation Question – Frame 2
Rating ScaleThis line represents how someone would feel (physically and emotionally) living with Cancer. Think about the bottom of the line as being the same as dead (0). Think about the top of the line as having the best health you can imagine (100).
Use the arrow to show at what point on this line you would put how YOU AND YOUR SPOUSE would feel, physically and emotionally, if your spouse was experiencing Cancer. You can move the arrow up and down until you get to the point on the line that represents how YOU AND YOUR SPOUSE would feel (physically and emotionally) if YOUR SPOUSE had Cancer.
100
90
80
70
60
50
40
30
20
10
0
Being Dead
Best Health You Can Imagine
Sample Valuation Question – Frame 2
Standard GambleThis Think about YOUR SPOUSE having Cancer.
Think about how YOUR AND YOUR SPOUSE feel, both physically and emotionally, about YOUR SPOUSE having Cancer. Now imagine that you were offered a choice: You could take this magic pill, which will instantly get rid of YOUR SPOUSE’S Cancer, but there is sometimes a chance of dying from a severe side effect. Remembering what your spouse’s condition is like, which would you choose, to take the pill or not take the pill?
Take the pill: You take the pill, with a 50% chance of getting rid of YOUR SPOUSE’s condition, and 50% chance of a deadly side effect for YOU.
Do not take the pill: YOU AND YOUR SPOUSE live with your spouse in this condition for the rest of your lives.
Spillover Disutility
Frame 2 – Composite Disutility
Frame 3 – Spillover Disutility
Analysis Plan• Multivariate regression analyses:• Standard gamble outcomes: GEE with negative binomial• Rating scale outcomes: Linear regression
• Outcome variable: Frame 2 (Composite Disutility) • Independent variables:• Spillover Disutility (Frame 3)• Condition • Relationship• Sociodemographic characteristics• Confidence in responses
• Secondary analyses
RespondentSamples
Characteristic Communityn=1205
Experiencedn=1389
Age:13-1718-5960+
N/A69%31%
7%57%36%
Condition valued:Alzheimer’s diseaseArthritisCancerCerebral PalsyDepression
11%20%26%16%27%
6%44%12% 1%36%
Relationship:ChildSpouseParent
32%33%35%
8%56%36%
Experienced sample (n=1369)
Community sample (n=1133)
Standard Gamble Results
Arthritis Alzheimer's
Cancer Depression0.0
0.2
0.4
0.6
0.8
1.0 Spouse
Arthritis Alzheimer's
Cancer Depression0.0
0.2
0.4
0.6
0.8
1.0 Parent
Cancer Depression0
0.2
0.4
0.6
0.8
1 Child
Arthritis Alzheimer's
Cancer Depression0.0
0.2
0.4
0.6
0.8
1.0 Spouse
Arthritis Alzheimer's
Cancer Depression0.0
0.2
0.4
0.6
0.8
1.0 Parent
Cancer Depression0
0.2
0.4
0.6
0.8
1 Child
Composite
Spillover
Qualitative Interviews:Domains most affected by family spillover
Somatic Health
• General emotional health
• Sadness/depression
• Worry/fear
• General mental health
• Stress/anxiety
Psychological Health
• Caretaking
• General daily activities• Finances
• Loss of old activities w/ill person
Non-Health
• General physical health • Physical pain
Source: Wittenberg et al., The Patient, 2013.
Rating Scale Results
Source: Lavelle et al., Applied Health Econ & Health Policy, 2014
Results Summary
• Spillover disutility small but measurable • Can be assessed using direct utility
assessment techniques• Varies by condition• Relationship between QOL and relationship
type not consistently significant• Level of caregiving not significant
Discussion
• Can spillover effects can be captured by traditional preference-based measures?• Future research :• Preferred approach: composite or individual?• Aspects of conditions that identify when
spillover should be considered?
Thank youQuestions/comments:
Lisa A. Prosser, Ph.D.CHEAR Unit, Division of General PediatricsUniversity of [email protected]