OBJECTIVES: The inclusion of utility values for carers and family members in economic evaluations is encouraged but not enforced by some health technology assessment agencies. The National Institute for Health and Care Excellence (NICE) in the UK promotes the inclusion of “all direct health effects for patients or, when relevant, carers” in its methods guide. This study assessed the extent to which utility values for carers and family members have been included in the recent health technology assessment appraisals (HTA) and highly specialised technology (HST) evaluations by NICE, published within the calendar year 2018.
METHODS: The Technology Appraisal Guidance of the HTAs and HSTs completed and published by NICE in 2018 were reviewed. The methods for estimation of carer and/or family member utility weights, whether they were included in the base case or as part of a scenario analysis, their impact on the incremental cost-effectiveness ratio (where reported), and comments by the evidence review group (ERG) and the appraisal committee (AC) were reviewed.
RESULTS: Of the 58 completed appraisals (56 HTAs and 2 HSTs), 2 included carer utility values and 1 included family member utility values in the economic evaluation. All 3 appraisals included utility values for the carer and/or family member as part of the analysis conducted from a payer perspective. In 2 of the 55 appraisals that did not include carer and/or family member utilities, the ERG and/or AC explicitly stated their preference for their inclusion.
CONCLUSIONS: Although the inclusion of carer and family member utility values is encouraged by some HTA authorities such as NICE, the evidence in recent submissions appraisals suggests that there is still a lag in the practice for their inclusion in economic evaluations submitted for reimbursement. Therefore, it is likely that most appraisals fail to capture all benefits of the treatments being evaluated.
