How does bereavement affect the health-related quality of life of household members who do and do not provide unpaid care? Difference-in-difference analyses using the UK household longitudinal survey

Background

Guidelines for modelling in economic evaluation recommend that it may be necessary to consider costs and outcomes until all modelled patients have died. Some guidelines also recommend that carers’ health-related quality of life (HRQoL) outcomes should be included. However, it is unclear whether economic evaluations should continue to include carers’ HRQoL after patients have died, and whether there is any evidence to support an additional bereavement effect for carers.

Methods

We used the UK Household Longitudinal Study waves 1–12. We used Difference-in-Differences to estimate the short- and long-term bereavement effects on the SF-6D for people who reported that they did and did not provide care to a household member who then died. We assumed parallel trends conditional on age, sex, long-term health conditions, education, and household income.

Results

Carers and non-carers experienced a significant loss in HRQoL in the year immediately following bereavement. Carers potentially experienced a loss in HRQoL in the year before bereavement, whereas the bereavement effect may have lasted longer for non-carers. For both groups, HRQoL became comparable to the non-bereaved population around 3 years after bereavement.

Conclusions

Bereavement has a statistically significant negative impact on HRQoL in the short-term, for both carers and non-carers. However, the effect size is small and is not sustained, suggesting that including bereavement in economic evaluation would make little difference to results.