Introduction Developing an instrument with an ambiguous construct can be challenging. With the capability approach, this is argued to be case, since the concept of capability by Sen is ambiguous in respect to the burdens that people experience whilst achieving their capabilities. A potential solution is to develop instruments with a more comprehensive concept of capability, such as the concept option-freedom. The concept option-freedom stresses the importance of achieving capabilities without impediments. However, this concept has not been operationalized for wellbeing assessment. The aim of this study is to develop a theoretical framework of wellbeing with the concept option-freedom. Methods A best-fit framework synthesis was conducted with seven papers that report qualitative findings which underpin capability instruments. First, the a-priori concept option-freedom was used to deductively code against. New codes, subthemes and themes were developed inductively when data did not match the a-priori concept. Results Four themes emerged from the synthesis. (1) Option Wellbeing represents a range of options that need to be satisfied in order for individuals to experience wellbeing. (2) Self-Realization represents that there are experiences in an individuals live that have value beyond realizing options. (3) Perceived Access to Options represents the perceived ability of individuals to realize freedoms. (4) Perceived Control represents the experience of having control. Conclusion Developing an instrument with the proposed framework has two benefits. First, it acknowledges the importance of assessing impediments in realizing capabilities for the assessment of wellbeing. Second, the themes form a broad informational base by including themes related to subjective wellbeing. The framework could be used as a broad base on which to assess the value of health technologies. Future research should study the feasibility of implementing the framework for the assessment of wellbeing.

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To analyse published evidence on the economic evaluation of risk‐based screening (RBS), a full systematic literature review was conducted. After a quality appraisal, we compared the cost‐effectiveness of risk‐based strategies (low‐risk, medium‐risk and high‐risk) with no screening and age‐based screening. Studies were also analysed for modelling, risk stratification methods, input parameters, data sources and harms and benefits. The 10 modelling papers analysed were based on screening performance of film‐based mammography (FBM) (three); digital mammography (DM) and FBM (two); DM alone (three); DM, ultrasound (US) and magnetic resonance imaging (one) and DM and US (one). Seven studies did not include the cost of risk‐stratification, and one did not consider the cost of diagnosis. Disutility was incorporated in only six studies (one for screening and five for diagnosis). None of the studies reported disutility of risk‐stratification (being considered as high‐risk). Risk‐stratification methods varied from only breast density (BD) to the combination of familial risk, genetic susceptibility, lifestyle, previous biopsies, Jewish ancestry and reproductive history. Less or no screening in low‐risk women and more frequent mammography screening in high‐risk women was more cost‐effective compared to no screening and age‐based screening. High‐risk women screened annually yielded a higher mortality rate reduction and more quality‐adjusted life years at the expense of higher cost and false positives. RBS can be cost effective compared to the alternatives. However, heterogeneity among risk‐stratification methods, input parameters, and weaknesses in the methodologies hinder the derivation of robust conclusions. Therefore, further studies are warranted to assess newer technologies and innovative risk‐stratification methods.