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Are Quality-Adjusted Life Years a Good Proxy Measure of Individual Capabilities?

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  • Paul Mark Mitchell

    (University of Bristol
    University Hospitals Bristol NHS Foundation Trust
    Southmead Hospital)

  • Sridhar Venkatapuram

    (King’s College London)

  • Jeff Richardson

    (Monash University)

  • Angelo Iezzi

    (Monash University)

  • Joanna Coast

    (University of Bristol
    University Hospitals Bristol NHS Foundation Trust)

Abstract

Background There is a debate in the health economics literature concerning the most appropriate way of applying Amartya Sen’s capability approach in economic evaluation studies. Some suggest that quality-adjusted life years (QALYs) alone are adequate while others argue that this approach is too narrow and that direct measures of capability wellbeing provide a more extensive application of Sen’s paradigm. Objective This paper empirically explores whether QALYs provide a good proxy for individual capabilities. Methods Data is taken from a multinational cross-sectional survey of individuals with seven health conditions (asthma, arthritis, cancer, depression, diabetes, hearing loss, heart disease) and a healthy population. Each individual completed the ICECAP-A measure of capability wellbeing for adults and six health utility instruments that are used to generate QALYs, including EQ-5D and SF-6D. Primary analysis examines how well health utility instruments can explain variation in the ICECAP-A using ordinary least squares regression. Results The findings show that all seven health conditions have a negative association on overall capability as measured by the ICECAP-A index. Inclusion of health utility instruments into separate regressions improves the predictive power of capability but on average, explains less than half of the variation in capability wellbeing. Individuals with arthritis appear to be less inhibited in terms of capability losses when accounting for health utility, yet those who have depression record significant reductions in capability relative to the healthy population even after accounting for the most commonly used health utility instruments. Conclusion The study therefore casts doubt on the ability of QALYs to act as a reliable proxy measure of individuals’ capability.

Suggested Citation

  • Paul Mark Mitchell & Sridhar Venkatapuram & Jeff Richardson & Angelo Iezzi & Joanna Coast, 2017. "Are Quality-Adjusted Life Years a Good Proxy Measure of Individual Capabilities?," PharmacoEconomics, Springer, vol. 35(6), pages 637-646, June.
    • Handle: RePEc:spr:pharme:v:35:y:2017:i:6:d:10.1007_s40273-017-0495-3
    DOI: 10.1007/s40273-017-0495-3
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    References listed on IDEAS

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    1. Simon, Judit & Anand, Paul & Gray, Alastair & Rugkåsa, Jorun & Yeeles, Ksenija & Burns, Tom, 2013. "Operationalising the capability approach for outcome measurement in mental health research," Social Science & Medicine, Elsevier, vol. 98(C), pages 187-196.
    2. Culyer, A J, 1989. "The Normative Economics of Health Care Finance and Provision," Oxford Review of Economic Policy, Oxford University Press and Oxford Review of Economic Policy Limited, vol. 5(1), pages 34-58, Spring.
    3. Coast, Joanna & Smith, Richard D. & Lorgelly, Paula, 2008. "Welfarism, extra-welfarism and capability: The spread of ideas in health economics," Social Science & Medicine, Elsevier, vol. 67(7), pages 1190-1198, October.
    4. Coast, Joanna & Flynn, Terry N. & Natarajan, Lucy & Sproston, Kerry & Lewis, Jane & Louviere, Jordan J. & Peters, Tim J., 2008. "Valuing the ICECAP capability index for older people," Social Science & Medicine, Elsevier, vol. 67(5), pages 874-882, September.
    5. Coast, Joanna, 2009. "Maximisation in extra-welfarism: A critique of the current position in health economics," Social Science & Medicine, Elsevier, vol. 69(5), pages 786-792, September.
    6. Terry N. Flynn & Elisabeth Huynh & Tim J. Peters & Hareth Al‐Janabi & Sam Clemens & Alison Moody & Joanna Coast, 2015. "Scoring the Icecap‐a Capability Instrument. Estimation of a UK General Population Tariff," Health Economics, John Wiley & Sons, Ltd., vol. 24(3), pages 258-269, March.
    7. Richard Smith & Paula Lorgelly & Hareth Al-Janabi & Sridhar Venkatapuram & Joanna Coast, 2012. "The Capability Approach: An Alternative Evaluation Paradigm for Health Economics?," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 39, Edward Elgar Publishing.
    8. Joanna Coast & Richard Smith & Paula Lorgelly, 2008. "Should the capability approach be applied in Health Economics?," Health Economics, John Wiley & Sons, Ltd., vol. 17(6), pages 667-670, June.
    9. Böckerman, Petri & Johansson, Edvard & Saarni, Samuli I., 2011. "Do established health-related quality-of-life measures adequately capture the impact of chronic conditions on subjective well-being?," Health Policy, Elsevier, vol. 100(1), pages 91-95, April.
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    Cited by:

    1. Paul Mark Mitchell & Rachael L. Morton & Mickaël Hiligsmann & Samantha Husbands & Joanna Coast, 2023. "Estimating loss in capability wellbeing in the first year of the COVID-19 pandemic: a cross-sectional study of the general adult population in the UK, Australia and the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(4), pages 609-619, June.
    2. Lidia Engel & Duncan Mortimer & Stirling Bryan & Scott A. Lear & David G. T. Whitehurst, 2017. "An Investigation of the Overlap Between the ICECAP-A and Five Preference-Based Health-Related Quality of Life Instruments," PharmacoEconomics, Springer, vol. 35(7), pages 741-753, July.
    3. Myles-Jay Linton & Paul Mark Mitchell & Hareth Al-Janabi & Michael Schlander & Jeff Richardson & Angelo Iezzi & Jasper Ubels & Joanna Coast, 2020. "Comparing the German Translation of the ICECAP-A Capability Wellbeing Measure to the Original English Version: Psychometric Properties across Healthy Samples and Seven Health Condition Groups," Applied Research in Quality of Life, Springer;International Society for Quality-of-Life Studies, vol. 15(3), pages 651-673, July.

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