Including health spillovers in economic evaluations

Patient chronic illness and disability impacts the health of family members and household members who experience psychological distress and care burden. These impacts, known as ‘health spillovers’, are typically ignored in economic evaluations, despite being relevant to ensuring maximum health benefits from scarce resources. This thesis explores methods for including health spillovers in economic evaluation. Three empirical studies were carried out. The first study generated evidence supporting the validity of the EQ-5D-5L and SF-6D for measuring health spillovers. The second study examined the health spillover from a behavioural intervention on related household members’ outcomes. Further trials are warranted which measure household member outcomes for patient health interventions. The third study demonstrated and applied a methodology which could be used to include health spillovers in a cost-utility analysis. The general conclusion is that family member costs/outcomes should be systematically accounted for in extra-welfarist economic evaluations, and though there remains uncertainty about the best way to achieve this, the findings from this thesis show that this is possible and advance the methods forward