Assessing sufficient capability: A new approach to economic evaluation

Abstract

Amartya Sen's capability approach has been discussed widely in the health economics discipline. Although measures have been developed to assess capability in economic evaluation, there has been much less attention paid to the decision rules that might be applied alongside. Here, new methods, drawing on the multidimensional poverty and health economics literature, are developed for conducting economic evaluation within the capability approach and focusing on an objective of achieving "sufficient capability". This objective more closely reflects the concern with equity that pervades the capability approach and the method has the advantage of retaining the longitudinal aspect of estimating outcome that is associated with quality-adjusted life years (QALYs), whilst also drawing on notions of shortfall associated with assessments of poverty. Economic evaluation from this perspective is illustrated in an osteoarthritis patient group undergoing joint replacement, with capability wellbeing assessed using ICECAP-O. Recommendations for taking the sufficient capability approach forward are provided.

Maximizing Health or Sufficient Capability in Economic Evaluation? A Methodological Experiment of Treatment for Drug Addiction

“…A recently published literature review highlighted that the sufficiency goal was more commonly encountered in the capabilities literature than maximisation [33], and indeed, sufficiency is closely related to the equality in the space of capabilities that Amartya Sen advocated [34]. A method for incorporating this within an economic evaluation framework has recently been developed [35]. This 'Sufficient Capability' approach prioritises individuals below a normatively sufficient level of capability and aims to maximise the number of people in society that achieve sufficient capability [35].…”

We Propose a Novel Measure for Social Welfare and Public Health: Capability-Adjusted Life-Years, CALYs

“…This has been transformed to a descriptive capability-based system labelled ICECAP-A, and complemented with weights to the five attributes divided into four levels of response [11]. A new approach in economic evaluation, with the objective of achieving ''sufficient capability'', has also been suggested by Mitchell et al [12]. This method has a longitudinal dimension such as QALYs, but is focused on assessing equity in terms of shortfall from sufficient capability.…”

Untitled

“…38 The expansion of freedom is also central to the CA and Sen 19 57 The application of the CA within health economics enables a broader measurement of wellbeing than most other approaches. 53 A major challenge in applying this approach to health is to develop research instruments that can capture capability for use in health interventions. 45,59,36,60,61,62,46 As this paper deals with the application of ICTs to health, it is critical to be aware of the large volume of work associated with the CA and technology in general and ICTs in particular.…”