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Choice of Outcome Measure in an Economic Evaluation: A Potential Role for the Capability Approach

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Abstract

The last decade has seen a renewed interest in Sen’s capability approach; health economists have been instrumental in leading much of this work. One particular stream of research is the application of the approach to outcome measurement. To date, there have been a dozen attempts (some combined) to operationalise the approach, and produce an outcome measure that offers a broader evaluative space than health-related quality-of-life measures. Applications have so far been confined to public health, physical, mental health and social care interventions, but the capability approach could be of benefit to evaluations of pharmacotherapies and other technologies. This paper provides an introduction to the capability approach, reviews the measures that are available for use in an economic evaluation, including their current applications, and then concludes with a discussion of a number of issues that require further consideration before the approach is adopted more widely to inform resource allocation decisions.

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Notes

  1. The most commonly used instrument to elicit utility values is the EQ-5D [4].

  2. Another possibility is to utilise cost consequence analysis (CCA) [8]; however, the non-aggregated format of the information means the decision maker must make inferences about aggregation, weighting and attribute values. These decisions are often implicit, which detracts from the need for explicit and transparent decision making.

  3. Other solutions posited include the use of experienced utility [15] or the measurement of happiness/life satisfaction/wellbeing [16, 17].

  4. Note that one of the most detailed comparison studies, the multi-instrument comparison (MIC) study includes ICECAP-A and six other MAUIs (EQ-5D-5L, AQoL-8D, HUI3, 15D, QWB and the SF-6D) [37].

  5. The same could also be said for the first ICECAP instrument, the ICECAP-O. It started with a need to develop an instrument for older people that went beyond health. It was only upon analysing qualitative interview responses that the capability to achieve certain functionings was identified as relevant.

  6. Note that Jones et al. [40] discussed above is comparing the ICECAP-O with ASCOT.

  7. Note that in 2005 NICE subsumed the role of the Health Development Agency, and was tasked with providing guidance on the effectiveness and cost effectiveness of public health interventions, and in 2013 NICE was given new responsibilities to produce guidance and quality standards for social care.

  8. ADHD is also associated with a range of co-morbidities [49].

  9. Notwithstanding the fact that the thresholds that do exist are potentially incorrect [56].

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Acknowledgments

The author would like to acknowledge the ICECAP team, particularly Prof. Joanna Coast and Dr Philip Kinghorn, for providing an anonymised registry of trials and studies that are using the ICECAP instruments. The author has no conflicts of interest.

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  1. Centre for Health Economics, Monash University, 15 Innovation Walk, Clayton, VIC, 3800, Australia

    Paula K. Lorgelly

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Lorgelly, P.K. Choice of Outcome Measure in an Economic Evaluation: A Potential Role for the Capability Approach. PharmacoEconomics 33, 849–855 (2015). https://doi.org/10.1007/s40273-015-0275-x

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