title: Implications of spillover effects within the family for medical cost-effectiveness analysis.
abstract: Medical cost-effectiveness analyses traditionally treat patients as isolated individuals and neglect the effects of improvement in patients' health on the welfare of their family members. We use a model based on a family utility function with altruistic linkages to show that there can be direct and indirect effects on the welfare of all family members. We focus specially on a model of how the spillover effects to the spouse in a two-person family might affect choice of treatments for prostate cancer. We then test the predictions of this model by analyzing treatment choices of prostate cancer patients using the linked SEER-Medicare database. We find that our results are consistent with the model's predictions. We conclude that cost-effectiveness analyses may better reflect the full costs and benefits of medical interventions if they incorporate these family effects. However, concerns about equity present a dilemma for the practice of CEA from the societal perspective.
authors.affiliation: Section of General Internal Medicine, Department of Medicine, University of Chicago, 5841 S. Maryland Ave., MC 2007, Office B201, Chicago, IL 60637, USA. abasu@uchicago.edu
authors.forename: Anirban
authors.initials: A
authors.lastname: Basu
authors.forename: David
authors.initials: D
authors.lastname: Meltzer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D005190:Family; D006801:Humans; D008297:Male; D006278:Medicare; D015233:Models, Statistical; D011471:Prostatic Neoplasms / Q000191:economics* / Q000628:therapy; D019057:Quality-Adjusted Life Years; D014481:United States