The term “Carer QALY” was coined in a paper Mott et al. (2023) and was identified as the following
“When caregiver quality of life is taken into account, an effective treatment that provides a survival benefit (with relatively small or no quality of life benefit) may appear less effective than a comparator therapy.”
Although the term “nurser QALY trap” is new, the problem has long been known.In fact, the patient QALY trap—that extending the life of someone with a chronic disease is less valuable than extending the life of someone without it—is driven by Ubel et al. (2000) Among other things.this
Tilford and Taran (2023)Editorial – Citations Quotes Lundin and Ramsberger (2008)–Explain the caregiver QALY trap using a metaphor as follows:
Lundin and Ramsberger depict two people on an island who need to decide whether to create a snakebite antidote to save the life of a snakebite. The island's snakes inhabit areas with better food, and picking fruit there would improve the quality of life for the island's two residents, but there is a risk of being bitten while picking the fruit. In Lundin and Ramsberg's fable, if a person is bitten and survives using the antidote, the survivor's quality of life will be very low. Healthy people will then have to provide food for the snakebite survivors, thus incurring survivor consumption costs. The link to the caregiver QALY trap is simple; healthy individuals lose QALYs when providing food to someone bitten by a snake.
A similar example is considering a treatment to extend the survival of children with severe brain injuries. Extending lifespan will create few adjusted life years (QALYs) for the patient due to lower quality of life; in addition, the caregiver's quality of life will also be reduced. Therefore, similar to the case of snake bites, life-extending treatments for brain injuries may not result in a net social health benefit.
The numerical example of Mott et al. under.
The author points out that this is not just a theoretical question:
In two recent National Institute for Health and Care Excellence (NICE) technology reviews (TA588 and TA755), incorporating carer quality of life into economic models resulted in fewer QALYs generated by a new treatment, resulting in the treatment being deemed not cost-effective . This means that life-prolonging treatments may not represent an efficient use of resources, at least in part because they can have a negative QALY impact on informal caregivers.
While caring for someone with a disability may have reduced temporary utility—because it is physically and emotionally strenuous—if we consider the altruistic effect (the positive value of extending a loved one’s life) or the bereavement effect (the negative impact), the caregiver’s Quality of life may improve. death) in the calculation. As an economist, I certainly rely on numerical analysis to assess treatment value; however, the Nursing QALY Trap highlights that whenever you conduct a health technology assessment, you need contextual considerations and qualitative information to supplement qualitative analysis.
