The concept of “Carer QALY” was introduced by Mott et al. in 2023, referring to the scenario where a treatment providing survival gains but no quality of life improvement might appear less effective than comparators when carer quality of life is taken into account.
While this term is new, the issue has been recognized for years. The “patient QALY trap” was identified by Ubel et al. in 2000, among others. TIlford and Tarlan’s editorial, citing Lundin and Ramsberg, uses a parable to illustrate the carer QALY trap.
Lundin and Ramsberg’s parable depicts two people on an island deciding whether to create a snake bite antidote. If one person is bitten and survives using the antidote, their quality of life would be very low. The healthy person would then incur survivor consumption costs by caring for the survivor, resulting in a loss of QALYs.
A similar example involves a treatment prolonging the life of a child with severe brain damage. This would create few QALYs for the patient and also cause a decline in caregiver quality of life, resulting in little to no net societal health gains.
Recent National Institute for Health and Care Excellence (NICE) technology appraisals have shown that considering carer quality of life in economic models can lead to fewer QALYs being accrued with new treatments, impacting their cost-effectiveness.
Contextual considerations and qualitative information are essential when conducting health technology assessment to address the carer QALY trap.
