Economic Evaluation of Informal Care and Health Spillover Effects

Informal care—unpaid support provided by family members, friends or neighbours—accounts for a substantial share of total societal care costs. Economic evaluation that omits these contributions and the attendant health spillover effects on caregivers risks undervaluing interventions and distorting policy decisions. Informal care imposes both direct and indirect costs: the former include time use and out-of-pocket expenditures, while the latter encompass lost earnings, reduced participation in leisure and adverse effects on carers’ physical and mental health. Health spillover effects refer to the impact of a patient’s health status or healthcare intervention on the well-being of family networks. Incorporating these effects within cost–effectiveness analysis can significantly alter incremental cost–utility ratios: multipliers may be applied to quality-adjusted life years (QALYs) to internalise benefits accruing beyond the index patient. Methodological advances include capability and well-being measures tailored to carers, discrete choice experiments to value time inputs, and frameworks adapting the conventional decision rule to capture displaced as well as generated spillovers. Application of these approaches has spanned dementia, chronic illness and vaccination programmes, highlighting the global significance of informal care and reinforcing the need for comprehensive societal perspectives in resource allocation.

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Economic Evaluation of Informal Care and Health Spillover Effects publication trend

The graph below shows the total number of articles in economic evaluation of informal care and health spillover effects across all publications each year (not limited to Nature Index journals).

Technical terms

Informal care: Unpaid assistance provided by non-professional caregivers to support daily living and health needs of family or community members.

Health spillover effects: Impacts of a patient’s illness or treatment on the health outcomes and quality of life of their informal caregivers and wider social network.

Quality-adjusted life year (QALY): A metric combining life expectancy and health-related quality of life on a scale where 0 represents death and 1 full health.

Multiplier effect: A factor applied in economic evaluation to capture additional health gains or losses experienced by caregivers and displaced elsewhere when funding a healthcare intervention.

Capability approach: An evaluative framework emphasising individuals’ freedoms and opportunities to achieve well-being, often operationalised through instruments that extend beyond health status alone.

References

1. Exploring the burden and support needs of informal caregivers for the older adults in Kazakhstan: a mixed-methods study protocol. Frontiers in Public Health (2024).
2. Validity and Responsiveness of Preference-Based Quality-of-Life Measures in Informal Carers: A Comparison of 5 Measures Across 4 Conditions. Value in Health (2020).
3. A Framework for Including Family Health Spillovers in Economic Evaluation. Medical Decision Making (2015).