Measuring Health Spillover Effects in Caregivers of Children with Autism Spectrum Disorder: A Comparison of the EQ-5D-3L and SF-6D

Abstract

Background and Objective Healthcare interventions that improve the health of children with autism spectrum disorder (ASD) have the potential to affect the health of caregivers. This study compares the three-level EuroQoL-5 Dimension (EQ-5D-3L) and the Short Form-6 Dimension (SF-6D) in their ability to value such spillover effects in caregivers. Methods Clinical data collected from two Autism Treatment Network (ATN) sites was combined with survey data of caregivers of children diagnosed with ASD. Caregivers completed instruments by proxy describing child health and completed the EQ-5D-3L and SF-6D preference-weighted instruments to describe their own health. Results There was a strong correlation between the health utility scores of the two preference-weighted instruments ( ρ = 0.6172, p < 0.001) measuring caregiver health-related quality of life. There was a similar correlation between both the SF-6D and EQ-5D-3L scores with a previously validated care-related quality of life measure (Care-related Quality of Life instrument [CarerQol-7D]) ( ρ = 0.569, p < 0.001 and ρ = 0.541, p < 0.001, respectively). The mean SF-6D scores for caregivers differed significantly in relation to four of the five child health or behavior measures whereas the EQ-5D-3L differed for only two of them. Conclusions Health utility values of caregivers for children with ASD vary by the health characteristics of the child, suggesting significant potential for spillover effects. The comparison of the EQ-5D-3L and SF-6D demonstrated that both instruments can be used to estimate spillover effects of interventions to improve child health, but the SF-6D exhibited greater sensitivity to child health among children with ASD. Electronic supplementary material The online version of this article (10.1007/s40273-019-00789-2) contains supplementary material, which is available to authorized users.

Advances in Methods and Novel Applications for Measuring Family Spillover Effects of Illness

“…Three papers in this issue address questions relating to the measurement of spillover health utilities for caregivers and family members. Brown et al and Lavelle et al measure health spillover effects in caregivers or parents of children with autism; Brown et al using indirect methods (EQ-5D and SF-6D) and Lavelle et al using a direct assessment (time trade-off questions) [12,13]. An overview paper by Wittenberg et al provides a comprehensive catalog of caregiver/ family member utilities in the literature organized into three groupings: health utilities that isolate the change in quality of life associated with spillover, health utilities of a caregiver/family member sample and a comparison or control group, and health utilities of caregivers/family members alone (no comparison group) [14].…”

Emerging biomarkers in autism spectrum disorder: a systematic review

“…Children with ASD require significant support from the educational, medical and social systems that results in a significant economic burden (3) which is estimated to cost the US approximately $268 billion in 2015 (4). In addition, the disability of a child creates a spillover effect, decreasing the quality of life for the entire family (5)(6)(7).…”

Cost-Effectiveness of 4CMenB Infant Vaccination in England: A Comprehensive Valuation Considering the Broad Impact of Serogroup B Invasive Meningococcal Disease

“…9 New research shows health spillovers impact caregivers and families in other diseases such as autism and Alzheimer's disease as well. 75 Here also, an evolution in health economic methods is noted, with more recent proposals on guideline updates and recommendations emphasizing the need to consider health spillover effects in the analysis. 74,75 Similar to Christensen et al (2014), 36 the present model introduced QALY weighting using the QAF to reflect society's preferences.…”

“…75 Here also, an evolution in health economic methods is noted, with more recent proposals on guideline updates and recommendations emphasizing the need to consider health spillover effects in the analysis. 74,75 Similar to Christensen et al (2014), 36 the present model introduced QALY weighting using the QAF to reflect society's preferences. This approach was taken because England uses a fixed cost-effectiveness threshold; however, where no fixed costeffectiveness threshold is used, an alternative to the QAF approach is to potentially consider the cost-effectiveness results in relation to society's preferences regarding prevention of severe disease, as done in Norway 76 and The Netherlands.…”