The Development of Capability Measures in Health Economics: Opportunities, Challenges and Progress

Abstract

Recent years have seen increased engagement amongst health economists with the capability approach developed by Amartya Sen and others. This paper focuses on the capability approach in relation to the evaluative space used for analysis within health economics. It considers the opportunities that the capability approach offers in extending this space, but also the methodological challenges associated with moving from the theoretical concepts to practical empirical applications. The paper then examines three 'families' of measures, Oxford Capability instruments (OxCap), Adult Social Care Outcome Toolkit (ASCOT) and ICEpop CAPability (ICECAP), in terms of the methodological choices made in each case. The paper concludes by discussing some of the broader issues involved in making use of the capability approach in health economics. It also suggests that continued exploration of the impact of different methodological choices will be important in moving forward.

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

“…The developers of these instruments and other proponents posit that the broader evaluative space of the capability approach means that both health and non-health outcomes, like empowerment, participation and choice, which individuals may value and thus could enhance their capabilities, are captured and can be considered when evaluating the effectiveness of an intervention or initiative. A recent paper by Coast and colleagues discusses this evaluative space and the opportunities it offers as well as the challenges [21].…”

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

“…Differences exist, not only in measurement, but also in decision rules and valuation where the extra-welfarism commonly applied remains inherently welfarist in practice [23, 61]. Progress has been made in developing a capability approach alternative to standard practice in terms of measures of capability [16, 62], decision rules by moving towards a sufficient capability objective [63, 64], and valuation with best–worst scaling DCE offering a mechanism for estimating the relative importance of different capability states [30]. Further research is still required, particularly on how a unit of capability gain, however defined, is monetarily valued before a fully workable alternative to the conventional QALY approach can be provided to decision makers.…”

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

“…As such, our questions will measure perceived capabilities using phrases similar to, e.g. ''being able'' in ICECAP-A [18].…”

“…Other capability measures, e.g. ICECAP-A [18] and OCAP-18 [24], follow a more inductive tradition of participatory research. Regarding the CALY-weights, we suggest that a sample from the general population make an external valuation, in order to minimize the ''happy slave'' problem.…”