A Framework for Including Family Health Spillovers in Economic Evaluation

Med Decis Making. 2016 Feb;36(2):176-86. doi: 10.1177/0272989X15605094. Epub 2015 Sep 16.


Health care interventions may affect the health of patients' family networks. It has been suggested that these "health spillovers" should be included in economic evaluation, but there is not a systematic method for doing this. In this article, we develop a framework for including health spillovers in economic evaluation. We focus on extra-welfarist economic evaluations where the objective is to maximize health benefits from a health care budget (the "health care perspective"). Our framework involves adapting the conventional cost-effectiveness decision rule to include 2 multiplier effects to internalize the spillover effects. These multiplier effects express the ratio of total health effects (for patients and their family networks) to patient health effects. One multiplier effect is specified for health benefit generated from providing a new intervention, one for health benefit displaced by funding this intervention. We show that using multiplier effects to internalize health spillovers could change the optimal funding decisions and generate additional health benefits to society.

Keywords: economic evaluation; extra-welfarism; family; informal care; spillovers.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Caregivers / economics
  • Caregivers / psychology
  • Cost of Illness*
  • Cost-Benefit Analysis / methods*
  • Costs and Cost Analysis
  • Family Health / economics*
  • Family Relations
  • Family*
  • Health Care Rationing / methods*
  • Humans
  • Models, Econometric