Evidence of Spillover of Illness among Household Members: EQ-5D Scores from a US Sample
ABSTRACT BACKGROUND: / OBJECTIVES: : The effects of illness extend beyond the individual to caregivers and family members. This study identified evidence of spillover of illness onto household members' health-related quality of life. METHODS: Medical Expenditures Panel Survey (MEPS) data from 2000-2003 were analyzed using multivariable regression to identify spillover of household members' chronic conditions onto individuals' health-related quality of life as measured by the EuroQol-5D (EQ-5D) score (N = 24,188). Spillover was assessed by disease category, timing of occurrence (preexisting or new conditions), and age of the household member (adult or child). RESULTS: : Controlling for an individual's own health conditions and other known predictors of EQ-5D scores, the authors found that the odds of an individual reporting full health (an EQ-5D score of 1.0, relative to <1.0) were lower with the presence of existing mental (odds ratio 0.71; 95% confidence interval, 0.64-0.79), respiratory (0.85; 0.75-0.97), and musculoskeletal (0.83; 0.75-0.93) conditions among adults and with mental (0.72; 0.62-0.82) and respiratory (0.80; 0.81-0.96) conditions among children in the household. The odds of an individual reporting full health were also lower for newly occurring chronic conditions in the household, including adults' mental (0.79; 0.65-0.97), nervous/sensory system (0.76; 0.61-0.96), and musculoskeletal (0.78; 0.65-0.95) conditions and children's mental conditions (0.64; 0.48-0.86). EQ-5D dimensions may be unsuited to fully capture spillover utility among household members, and MEPS lacks condition severity and caregiver status among household members. CONCLUSIONS: : Evidence from a US sample suggests that individuals who live with chronically ill household members have lower EQ-5D scores than those who live either alone or with healthy household members. Averting spillover effects may confer substantial additional benefit at the population level for interventions that prevent or alleviate conditions that incur such effects.
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ABSTRACT: BACKGROUND: Caring for an ill or disabled family member imposes a well-documented burden on the caregiver. The benefits of a health intervention may be underestimated if "spillover" effects on family members are not captured, resulting in inaccurate conclusions of economic evaluations. OBJECTIVE: To provide an estimate of, and to summarize measurement approaches for, the spillover disutility of illness on family members, relatives, and caregivers, through a systematic review of the literature. METHODS: The medical (PubMED), psychology (PsycINFO), and economics (EconLit) literatures were searched from inception through February 2012 for published studies measuring spillover disutility of illness on family members and caregivers. Inclusion criteria were (1) studies using preference-based measures of health-related quality of life, and (2) studies reporting spillover disutility, or (3) studies reporting data from which a spillover disutility could be inferred. RESULTS: Fifteen studies were included in this review: seven reported estimates of spillover disutility and eight reported data from which disutility could be inferred. Three studies found no disutility associated with spillover, whereas 12 found measurable effects as large as -0.718 (and two found evidence of positive spillover in subsets of their samples). Generic (indirect) utility instruments were primarily used to measure spillover, including the EQ-5D, QWB, and HUI (n = 13), though two studies used modified versions of the time trade-off technique. Illnesses studied included childhood disorders (e.g., spina bifida, congenital malformations), diseases of the elderly (e.g., Alzheimer's disease and dementia), physically disabling conditions (e.g., arthritis, multiple sclerosis), and medical conditions such as cancer and stroke. The persons affected by spillover included parents, grandparents, spouses/partners, other family caregivers, and household members. CONCLUSIONS: There is a limited literature on the spillover disutility of illness on family members and caregivers, providing some specific estimates of a generally small, negative effect for particular conditions and individuals. Measurement methods vary across studies and a consensus approach has not yet been reached. Evidence suggests that the inclusion of spillover effects in economic evaluations would increase the relative effectiveness of interventions that address conditions with spillover compared to those without, though such differential benefits may be limited to such specific circumstances.PharmacoEconomics 04/2013; 31(6). DOI:10.1007/s40273-013-0040-y · 3.34 Impact Factor
- 05/2013; 167(7):1-2. DOI:10.1001/jamapediatrics.2013.165
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ABSTRACT: Spillover effects of illness on family members can be substantial. The objective of this study was to identify the domains of family members' health and well-being that are affected when a relative has a chronic health condition. Semi-structured telephone interviews were conducted in February 2012 with 49 individuals whose relatives had any of five chronic health conditions (arthritis, cancer, Alzheimer's disease/dementia, cerebral palsy, and depression), purposively sampled to include different relationships with the ill relative (parent, child, spouse). Subjects were queried on whether and how having an ill relative affected their health and well-being; they were also asked about their caregiving responsibilities and the relative's health. Interview data were analyzed using thematic analysis. Family members in our sample reported experiencing psychological and non-health effects from having an ill relative, and secondarily somatic effects. Effects on emotional health were most commonly reported as psychological spillover; non-health effects frequently included changes in daily activities and provision of caregiving. Spouses of patients reported the broadest range of spillover domains affected and adolescents of ill parents the fewest. Family members reported experiencing effects that were perceived as both positive and negative. Spillover of illness onto family members encompasses a wide range of domains of health and well-being, extending beyond those included in many existing health-related quality of life measures. Outcomes measurement efforts should be expanded to adequately capture these health and well-being outcomes for analysis, to ensure that the benefits of interventions are accurately estimated and conclusions are valid.The patient 10/2013; 6(4). DOI:10.1007/s40271-013-0030-3 · 1.96 Impact Factor