title: QALYs and carers.
abstract: When going 'beyond the patient', to measure QALYs for unpaid carers, a number of additional methodological considerations and value judgements must be made. While there is no theoretical reason to restrict the measurement of QALYs to patients, decisions have to be made about which carers to consider, what instruments to use and how to aggregate and present QALYs for carers and patients. Current, albeit limited, practice in measuring QALY gains to carers in economic evaluation varies, suggesting that there may be inconsistency in judgements about whether interventions are deemed cost effective. While conventional health-related quality-of-life tools can, in theory, be used to estimate QALYs, there are both theoretical and empirical concerns over the suitability of their use with carers. Measures that take a broader view of health or well-being may be more appropriate. Incorporating QALYs of carers in economic evaluations may have important distributional consequences and, therefore, greater normative discussion over the appropriateness of incorporating these impacts is required. In the longer term, more flexible forms of cost-per-QALY analysis may be required to take account of the broader impacts on carers and the weight these impacts should receive in decision making.
authors.affiliation: Health Economics Unit, University of Birmingham, Birmingham, UK. h.aljanabi@bham.ac.uk
authors.forename: Hareth
authors.initials: H
authors.lastname: Al-Janabi
authors.forename: Terry N
authors.initials: TN
authors.lastname: Flynn
authors.forename: Joanna
authors.initials: J
authors.lastname: Coast
mesh_terms: D017028:Caregivers / Q000191:economics / Q000706:statistics & numerical data*; D003362:Cost-Benefit Analysis; D006801:Humans; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D019057:Quality-Adjusted Life Years
references.citation: Psychol Aging. 2003 Jun;18(2):250-67
references.pmid: 12825775
references.citation: Med Decis Making. 2011 May-Jun;31(3):458-68
references.pmid: 20924044
references.citation: Int Psychogeriatr. 2008 Dec;20(6):1160-76
references.pmid: 18606044
references.citation: Appl Health Econ Health Policy. 2010;8(1):25-35
references.pmid: 20038191
references.citation: Int J Technol Assess Health Care. 2000 Winter;16(1):111-24
references.pmid: 10815358
references.citation: J Health Econ. 2008 Mar;27(2):325-38
references.pmid: 18179835
references.citation: BMJ. 2004 May 8;328(7448):1102
references.pmid: 15130978
references.citation: Soc Sci Med. 1996 Jun;42(12):1691-701
references.pmid: 8783431
references.citation: Soc Sci Med. 1989;28(4):299-308
references.pmid: 2649989
references.citation: J Health Econ. 1992 Oct;11(3):259-77
references.pmid: 10122539
references.citation: Stroke. 1998 Aug;29(8):1605-11
references.pmid: 9707201
references.citation: J Health Serv Res Policy. 2008 Oct;13 Suppl 3:31-7
references.pmid: 18806190
references.citation: Qual Life Res. 1999 May;8(3):209-24
references.pmid: 10472152
references.citation: Pharmacoeconomics. 2006;24(1):43-53
references.pmid: 16445302
references.citation: Qual Life Res. 2006 Aug;15(6):1005-21
references.pmid: 16900281
references.citation: Health Econ. 1997 Mar-Apr;6(2):117-32
references.pmid: 9158965
references.citation: J Gerontol B Psychol Sci Soc Sci. 2003 Mar;58(2):P112-28
references.pmid: 12646594
references.citation: Health Econ. 2003 Aug;12(8):629-36
references.pmid: 12898661
references.citation: Pharmacoeconomics. 2008;26(4):269-80
references.pmid: 18370563
references.citation: J Pain Symptom Manage. 2003 Oct;26(4):922-53
references.pmid: 14527761
references.citation: Int J Geriatr Psychiatry. 2009 Jun;24(6):610-23
references.pmid: 19101921
references.citation: Int J Technol Assess Health Care. 1991;7(2):209-19
references.pmid: 1907599
references.citation: J Gerontol. 1989 May;44(3):P61-71
references.pmid: 2715587
references.citation: Med Decis Making. 2009 Jan-Feb;29(1):33-50
references.pmid: 18948433
references.citation: Soc Sci Med. 2003 Mar;56(5):1121-33
references.pmid: 12593883
references.citation: Soc Sci Med. 2008 Jul;67(1):111-21
references.pmid: 18436359
references.citation: Health Econ. 2005 Feb;14(2):197-208
references.pmid: 15386656
references.citation: Br Med J (Clin Res Ed). 1985 Aug 3;291(6491):326-9
references.pmid: 3160430
references.citation: JAMA. 1999 Dec 15;282(23):2215-9
references.pmid: 10605972
references.citation: Health Policy. 2005 Aug;73(2):172-82
references.pmid: 15978960
references.citation: Age Ageing. 2006 May;35(3):261-6
references.pmid: 16547118
references.citation: J Health Econ. 2005 Jul;24(4):751-73
references.pmid: 15960995
references.citation: Med Decis Making. 2011 Mar-Apr;31(2):292-8
references.pmid: 20671212
references.citation: Health Econ. 1994 May-Jun;3(3):137-48
references.pmid: 7921057
references.citation: Pharmacoeconomics. 1998 Jan;13(1 Pt 1):21-34
references.pmid: 10175983
references.citation: J Neurol Neurosurg Psychiatry. 2003 Feb;74(2):158-62
references.pmid: 12531939
references.citation: Alzheimer Dis Assoc Disord. 2001 Jul-Sep;15(3):129-36
references.pmid: 11522930
references.citation: J Health Econ. 2010 Jul;29(4):549-56
references.pmid: 20579755
references.citation: J Health Econ. 2002 Mar;21(2):271-92
references.pmid: 11939242
references.citation: Eur J Health Econ. 2004 Feb;5(1):36-45
references.pmid: 15452763
references.citation: Soc Sci Med. 2008 Sep;67(5):874-82
references.pmid: 18572295
references.citation: Pharmacoeconomics. 2006;24(1):39-41
references.pmid: 16445301
references.citation: N Engl J Med. 1977 Mar 31;296(13):716-21
references.pmid: 402576
references.citation: Med Care. 1999 Jan;37(1):27-32
references.pmid: 10413389
references.citation: Stroke. 1998 Feb;29(2):373-9
references.pmid: 9472877
references.citation: BMJ. 2008 Jan 19;336(7636):134-8
references.pmid: 18171718
references.citation: Qual Health Care. 1995 Sep;4(3):207-13
references.pmid: 10153432
references.citation: J Gerontol. 1983 May;38(3):344-8
references.pmid: 6841931