Toward a broader concept of societal value: family spillovers in Alzheimer's disease.

Jenny Yeonhee Park,Zachary A Marcum,Louis P Garrison

doi:10.1017/s0266462321000593

Abstract

Recognizing that the "healthcare sector perspective" can be too limited in some situations, the National Institute of Health and Care Excellence (NICE), Institute for Clinical and Economic Review (ICER), and the U.S. Second Panel on Cost-Effectiveness in Health and Medicine all recommend a "societal" perspective in "reference case" cost-effectiveness analyses (CEAs). Although costs of informal caregiving are sometimes included in the CEAs of Alzheimer's Disease (AD) drugs, the benefits and disutility to family members, referred to as "family spillovers" by the U.S. Second Panel, are usually omitted. We estimate that the aggregate cost of family spillovers could be substantial in the USA-on the order of USD 57 billion or over 10 percent of the total economic burden of AD in 2020. Incorporation of family spillovers in AD value frameworks and HTAs is important for comprehensively defining, rewarding, and providing high-value care in AD.

Highlights

Assessing Value from a Societal PerspectiveIn assessing value of new medicines to guide decisions about reimbursement and funding which affect resource allocation, it is important to remember that individuals have varying preferences for health technologies just as they do for other economic goods [1] and will, vary in their valuations
We estimate that the aggregate cost of family spillovers could be substantial in the USA—on the order of USD 57 billion or over 10 percent of the total economic burden of Alzheimer’s Disease (AD) in 2020
Current assessments of value by health technology assessment (HTA) organizations tend to take a “healthcare sector” perspective, and in doing so, may not comprehensively capture all treatment benefits and costs that matter to patients and their families [2;3]

Summary

Introduction

In assessing value of new medicines to guide decisions about reimbursement and funding which affect resource allocation, it is important to remember that individuals have varying preferences for health technologies just as they do for other economic goods [1] and will, vary in their valuations. In economic evaluation of health technologies, value is often assessed using CEA to measure and compare incremental costs and benefits of these health innovations; the comparative efficacy, safety, and costs between two interventions are assessed to inform reimbursement decisions. The EQ-5D—as a utility measure with a stronger focus on physical health—may be less sensitive in capturing the impact of caregiving on caregiver mental health, the results of the GERAS study and Adelphi Real World Dementia Disease-Specific Programme were used to estimate the aggregate cost of family spillovers. Economic evaluations from the societal perspective encompassing benefits and disutility for all individuals affected are better suited for more holistic value assessments of AD medications and other interventions. HTA process? Will the process take longer? Will there be ad hoc approaches? What would be the repercussions in the reimbursement process?

14. The Global Burden of Disease

21. Caregiver statistics

Findings

26. Caregiver statistics