Session (CTI)

Issue: Economic evaluation for health technology assessment (HTA) may include, as an outcome of relevance, health-related quality of life (HRQoL) for caregivers as well as patients, but there is a lack of consensus on how to do this. Popular methods to model caregiver’s HRQoL are fraught with difficulty and may result in the “caregiver quality-adjusted life year (QALY) trap”, whereby extended patient survival has a negative impact on the incremental cost-effectiveness ratio (ICER) due to losses in caregiver utilities (stemming from the prolonged provision of informal care). Methods are emerging which are designed to overcome some of these limitations, but their assumptions and implications require examination to understand whether they can be reconciled with caregivers’ experiences and the aims of HTA agencies. Overview: Ron Akehurst will introduce the topic (5 minutes). Fleur Chandler will present a caregiver’s perspective, describing her own experience of caregiving and the views of the caregiving community on how HTA includes caregivers’ HRQoL (10 minutes), informed by her background as a senior HTA practitioner. Becky Pennington will describe traditional methods for modelling caregiver’s HRQoL (caregiver utilities, disutilities, and increments) and emerging methods (multipliers, disentangling “caring for” and “caring about”) designed to overcome some of the limitations of traditional methods (15 minutes). Becky will speak from the perspective of HTA decision-makers using these approaches and also as an academic researcher developing new methods. Erik Landfeldt will present an industry perspective, describing how incorporating bereavement could overcome the caregiver QALY trap (8 minutes). The impacts of new and traditional methods of modelling caregivers’ HRQoL will be compared in a series of case studies (5 minutes). The moderator will welcome questions from the audience and oversee a debate between panellists on the extent to which current and emerging methods can be reconciled with caregiver’s experiences and HTA decision making (15 minutes).