Abstract
This article presents alternative parental health spillover quantification methods in the context of a randomised controlled trial comparing family therapy with treatment as usual as an intervention for self-harming adolescents, and discusses the practical limitations of those methods. The trial followed a sample of 754 participants aged 11-17years. Health utilities are measured using answers to the EuroQoL 5 Dimensions 3 Levels (EQ-5D-3L) for the adolescent and the Health Utility Index (HUI2) for one parent at baseline, 6 and 12months. We use regression analyses to evaluate the association between the parent's and adolescent's health utilities as part of an explanatory regression model including health-related and demographic characteristics of both the adolescent and the parent. We then measure cost-effectiveness over a 12-month period as mean incremental cost-effectiveness ratios using various spillover quantification methods. We propose an original quantification based on the use of a household welfare function along with an equivalence scale to generate a health gain within the family to be added to the adolescent's quality-adjusted life-year gain. We find thatthe parent's health utility increased over the duration of the trial and issignificantly and positively associated with adolescent's health utility at 6 and 12months but not at baseline. When considering the adolescent's health gain only, the incremental cost-effectiveness ratio is £40,453 per quality-adjusted life-year. When including the health spillover to one parent, the incremental cost-effectiveness ratio estimates range from £27,167 per quality-adjusted life-year to £40,838 per quality-adjusted life-year and can be a dominated option depending on the quantification method used. According to the health spillover quantification method considered, the incremental cost-effectiveness ratios vary from within the National Institute for Health and Care Excellence(NICE) cost-effectiveness threshold range to not being cost-effective.
Highlights
Self-harm is commonly defined in the UK and Europe as any form of non-fatal self-poisoning or self-injury, regardless of the motivation or degree of intention to die
We found that EQ-5D-3L had the least amount of missing data and presented limited problematic wording for that age group; the EQ-5D-3L was eventually used to measure the health-related quality of life (HRQoL) of adolescents in the trial
Assuming policy makers are interested in accountianrgmf,otrhberopaadrahmeaelttehrsbên10e, fi1t1sainnddêp12enredpernetslyenotf the treatment a utility gain for the parent at each time point, which can be transformed into a quality-adjusted life-years (QALYs) gain using the area under the curve approach as follows: QALYSi pe1
Summary
Self-harm is commonly defined in the UK and Europe as any form of non-fatal self-poisoning or self-injury (such as cutting, taking an overdose, hanging, self-strangulation, jumping from a height and running into traffic), regardless of the motivation or degree of intention to die. Individuals with mental disorders are heavy users of public health services and require emotional support and care from their family [2, 3] Their disorders are likely to affect other family members’ health and own healthcare needs, especially because individuals with mental health conditions face elevated rates of all-cause mortality and this places a huge burden of costs and life-years lost on the family and the community [4]. It appears that the magnitude of spillovers on the health of other family members is the greatest in parents of ill children [5, 6]. Therapy sessions do not necessarily include all family members, but it is expected that they will have an impact beyond the identified patient
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