Presentation (CTI)

OBJECTIVES: Incorporating bereavement effects is an important consideration when capturing caregiver spillover in health-related quality of life assessments. However, it is challenging to include bereavement effects given the lack of established methods, and uncertainties regarding the magnitude, duration of effect and the number of individuals affected. This study evaluated the impact of key assumptions surrounding the bereavement factor method as a first step towards comparing alternative approaches for incorporating bereavement effects in economic evaluations.
METHODS: This study extended an existing societal-perspective cost-effectiveness model for paediatric spinal muscular atrophy to evaluate the bereavement factor method with alternative approaches for incorporating caregiver spillover effects in economic evaluations.The base case assumption for bereavement was a duration of two years, with a grief disutility of -0.10 QALYs for the first year and -0.03 QALYs for the second year after the loss. The model assumed 1 caregiver per patient. Several scenario analyses were conducted to evaluate the impact of key assumptions regarding bereavement duration and disutilities values and their impact on incremental QALYs.
RESULTS: In the base-case, including the bereavement effect resulted in 1081.8 incremental QALYs. Excluding bereavement reduced the incremental QALYs by 0.37% to 1077.8 QALYs. Increasing the second-year disutility to -0.05 and -0.10 increased incremental QALYs by 0.10% and 0.34%. Extending the bereavement duration to four and eight years increased incremental QALYs by 0.13% and 0.39% respectively.
CONCLUSIONS: Incorporating bereavement effects provides a more comprehensive assessment of caregiver quality-of-life impacts in economic evaluations of paediatric conditions. Although bereavement assumptions influenced model outcomes, their overall impact on incremental QALYs was modest, with all scenario analyses resulting in changes of less than 0.5% relative to the base case.