Spillovers in Health Economic Evaluation and Research (SHEER) Task Force: Emerging Good Practice and Recommendations for a Future Research Agenda

Abstract:
Background: Omission of ‘family and caregiver health spillovers’ from the economic evaluation of healthcare
interventions remains common practice. When reported, a high degree of methodological inconsistency in
incorporating spillovers has been observed.
Aims: To promote “emerging good practice”, the Spillovers in Health Economic Evaluation and Research
(SHEER) task force aims to provide guidance on the incorporation of family and caregiver health spillovers in
cost-effectiveness and cost-utility analysis. SHEER also seeks to inform the basis for a spillover research agenda
and future practice.
Methods: A modified nominal group technique was used to reach consensus on a set of recommendations,
representative of the views of participating subject-matter experts.
Results: The report of the task force details 11 consensus recommendations for emerging good practice. SHEER
advocates for the incorporation of health spillovers into analyses conducted from a healthcare/health payer
perspective, and more generally inclusive perspectives such as a societal perspective. To the extent possible,
spillovers related to displaced/foregone activities should be considered, as should the distributional
consequences of inclusion. Time horizons ought to be sufficient to capture all relevant impacts. Currently, the
collection of primary spillover data is preferred and clear justification should be provided when using secondary
data. Transparency and consistency when reporting on the incorporation of health spillovers are crucial. The
still-nascent health spillover evidence base warrants much methodologic development and 12 avenues for future
research are thus prioritised.
Discussion: Consideration of health spillovers in economic evaluation has been called for by researchers and
policymakers alike. To this end, it is hoped that the consensus recommendations of SHEER will motivate more
widespread incorporation of health spillovers into analyses. The emergent nature of spillover research impels
that this guidance be viewed as an initial roadmap, rather than a strict checklist. Moreover, there is a need for
balance between consistency in approach, where valuable in a decision-making context, and variation, to reflect
differing decision-maker perspectives and to support innovation.

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