Valuing caregiver burden in palliative care

    Student thesis: Master's ThesisMaster of Science


    There is a clear need to account for caregiver burden in economic evaluations of healthcare interventions, since omitting it has the potential to produce skewed cost-effectiveness estimates. This is particularly important in palliative care, as interventions in this field are often explicitly intended to help patients’ families and informal caregivers as well as the patients themselves. However, caregiver burden is a complex concept with a number of different dimensions, so valuation can be a challenging task.
    This paper describes the different dimensions of caregiver burden and provides suggestions as to how those dimensions might be valued for inclusion in economic evaluations. Outcomes are found to be far more complex to value than costs, with considerable controversy over the appropriateness of quality adjusted life years (QALYs) as a unit of outcome both for palliative care and for informal care more generally.
    The results of a cost-effectiveness analysis of a palliative care intervention are also presented. This analysis was conducted both to demonstrate how to apply the valuation techniques discussed in the first section in practice, and to illustrate how accounting for caregiver burden can significantly affect the estimated cost-effectiveness of palliative care interventions. A simple two-state Markov model was used, with results reported both with and without caregiver burden taken into account. The intervention in question was a multidisciplinary service in southeast London for patients prone to breathlessness.
    Including both caregiver costs and outcomes in cost-effectiveness calculations was found to reduce the estimated incremental cost-effectiveness ratio (ICER) for the intervention from £103,744 to £26,194 per QALY. Sensitivity analyses revealed substantial uncertainty around these results due to the small sample size in the primary dataset.
    It is concluded that while accounting for caregiver burden when assessing the cost-effectiveness of palliative care interventions is vital and has the potential to significantly alter ICER estimates, further research on how best to value caregiver outcomes is required, since consensus in this area is necessary to ensure the consistency and comparability of cost-effectiveness estimates.
    Date of Award2014
    Original languageEnglish
    Awarding Institution
    • City, University of London

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