The Inclusion of Caregiver Burden in the National Institute for Health and Care Excellence (NICE) Health Technology Appraisals (HTAS) of Treatments for Mental Health Disorders

OBJECTIVES: NICE specifies caregiver burden is considered in the NICE reference case to maximize the health of a population; however, few HTAs consider it. There is significant caregiver burden associated with mental health disorders due to their intensity, duration, and age of onset. This analysis aimed to assess how often caregiver burden is considered within the NICE HTAs for treatments for mental health disorders, and to explore challenges and potential solutions for its inclusion in future submissions.

METHODS: HTAs for treatments that fell under the category for mental health, behavioral, and neurodevelopmental conditions were identified from NICE’s website. A data extraction form was created to capture whether caregiver burden was considered in each appraisal. The following documents were reviewed: manufacturers’ submissions, evidence assessment group reports, and final appraisal documents. The methods used to consider caregiver burden in terms of costs or disutilities were summarised, and any justification for exclusion was captured.

RESULTS:

Nine HTA submissions for mental health disorder treatments were identified. These included appraisals for treatments for alcohol-use disorders, bipolar disorder, Alzheimer’s disease, depression, drug misuse, psychosis and schizophrenia. Of the nine submissions, none included caregiver burden in the base case, but two considered it within scenario analyses. The methods included arbitrary increments in health state costs and disutilities, due to lack of data.

CONCLUSIONS: A challenge with including caregiver burden in cost-effectiveness models is the lack of data on the true costs associated with care and the direct effect treatment has on caregivers. Potential solutions include capturing caregiver impact in the associated treatments randomised-control trials or use of real-world evidence. Given the significant caregiver burden associated with mental health disorders, it is important to overcome the challenges associated with lack of data, so that NICE can consider the impact on the wider population in its decision-making process.