Sandy Tubeuf1,2, Eirini-Christina Saloniki3,4, David Cottrell5. 1. Academic Unit of Health Economics, University of Leeds, Leeds, LS2 9NL, UK. s.tubeuf@leeds.ac.uk. 2. Institute of Health and Society, Université Catholique de Louvain, Louvain-La-Neuve, Belgium. s.tubeuf@leeds.ac.uk. 3. Centre for Health Services Studies, University of Kent, Kent, UK. 4. Personal Social Services Research Unit, University of Kent, Kent, UK. 5. Psychological and Social Medicine, University of Leeds, Leeds, UK.
Abstract
OBJECTIVE: 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. METHODS: The trial followed a sample of 754 participants aged 11-17 years. 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 12 months. 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. RESULTS: We find that the parent's health utility increased over the duration of the trial and is significantly and positively associated with adolescent's health utility at 6 and 12 months 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. CONCLUSION: 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.
RCT Entities:
OBJECTIVE: 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. METHODS: The trial followed a sample of 754 participants aged 11-17 years. 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 12 months. 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. RESULTS: We find that the parent's health utility increased over the duration of the trial and is significantly and positively associated with adolescent's health utility at 6 and 12 months 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. CONCLUSION: 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.
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