The carer QALY trap

I discuss a commentary that introduces the 'carer QALY trap', an unsettling paradox where life-extending treatments can appear less cost-effective once you account for the quality of life toll on informal carers. When patients survive longer but with poor quality of life, carers lose QALYs too, potentially making interventions look worse from a societal perspective. This creates a genuine ethical minefield: do we deny life-extending care because of the impact on carers? Tillford's response shares a sobering example from paediatric brain injury research where more aggressive treatment could save children, but the outcome 'would not be worth it'. I explore proposed solutions (from scenario analyses to incorporating carer testimonials) and what this means for recent Financial Times coverage of the mental health toll on 'sandwich carers'.

[https://docs.google.com/presentation/d/1uVE962owge6hYc9uc0-i-Ahf-fI91hja1RanDAcE_yw/edit?usp=share_link](https://docs.google.com/presentation/d/1uVE962owge6hYc9uc0-i-Ahf-fI91hja1RanDAcE_yw/preview?usp=share_link)

Original article: Modelling spillover effects on informal carers: The carer QALY trap

Pharmacoeconomics; Sep 2, 2023

By David J. Mott, Hannah Schirrmacher, Hareth Al-Janabi, Sophie Guest, Becky Pennington, Nicolas Scheuer, Koonal K. Shah & Chris Skedgel

Modelling Spillover Effects on Informal Carers: The Carer QALY Trap

Cited in article

Family Spillover Effects: Are Economic Evaluations Misrepresenting the Value of Healthcare Interventions to Society?

Close-Person Spill-Overs in End-of-Life Care: Using Hierarchical Mapping to Identify Whose Outcomes to Include in Economic Evaluations

Modelling Informal Carers’ Health-Related Quality of Life: Challenges for Economic Evaluation

Caring for Carers: Positive and Normative Challenges for Future Research on Carer Spillover Effects in Economic Evaluation

Other

‘Sandwich carers’ suffer long mental health toll, study finds

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