The Relative Impacts of Disease on Health Status and Capability Wellbeing: A Multi-Country Study

Abstract

BackgroundEvaluations of the impact of interventions for resource allocation purposes commonly focus on health status. There is, however, also concern about broader impacts on wellbeing and, increasingly, on a person's capability. This study aims to compare the impact on health status and capability of seven major health conditions, and highlight differences in treatment priorities when outcomes are measured by capability as opposed to health status.MethodsThe study was a cross-sectional four country survey (n = 6650) of eight population groups: seven disease groups with: arthritis, asthma, cancer, depression, diabetes, hearing loss, and heart disease and one health population ‘comparator’ group. Two simple self-complete questionnaires were used to measure health status (EQ-5D-5L) and capability (ICECAP-A). Individuals were classified by illness severity using condition-specific questionnaires. Effect sizes were used to estimate: (i) the difference in health status and capability for those with conditions, relative to a healthy population; and (ii) the impact of the severity of the condition on health status and capability within each disease group.Findings5248 individuals were included in the analysis. Individuals with depression have the greatest mean reduction in both health (effect size, 1.26) and capability (1.22) compared to the healthy population. The effect sizes for capability for depression are much greater than for all other conditions, which is not the case for health. For example, the arthritis group effect size for health (1.24) is also high and similar to that of depression, whereas for the same arthritis group, the effect size for capability is much lower than that for depression (0.55). In terms of severity within disease groups, individuals categorised as 'mild' have similar capability levels to the healthy population (effect sizes <0.2, excluding depression) but lower health status than the healthy population (≥0.4).ConclusionSignificant differences exist in the relative effect sizes across diseases when measured by health status and capability. In terms of treating morbidity, a shift in focus from health gain to capability gain would increase funding priorities for patients with depression specifically and severe illnesses more generally.

Comorbidities and characteristics of coronary heart disease patients: their impact on health-related quality of life

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“…Although this number has been in decline for the last two decades, it has increased in low- and middle-income countries [1–4]. Moreover, patients with CVDs report significantly poorer health-related quality of life (HRQoL) as compared to the population without chronic diseases, similar to patients with other potentially disabling chronic conditions, such as diabetes, arthritis and depression [5, 6]. …”

“…CHD patients commonly present with more than one comorbid condition (e.g., cerebrovascular disease, peripheral artery disease or heart failure), and often have problems with anxiety and depression [7]. The functional capacity of the patient, quality of life and premature mortality all depend on these comorbid conditions, including the increasing costs of care of primary and comorbid conditions [1, 5]. Vascular comorbidities, heart failure (HF) and anxiety/depression disorders significantly affect not only the outcomes of CHD care but also HRQoL.…”

Measuring Health and Broader Well-Being Benefits in the Context of Opiate Dependence: The Psychometric Performance of the ICECAP-A and the EQ-5D-5L

“…Previous evidence has indicated that a shift from HrQoL to capability-wellbeing would prioritise funding for those suffering from depression and other severe illnesses [66]. Based on the findings of this study, this is also likely to be the case for the context of drug addiction, where treatment objectives extend beyond the improvement of health.…”

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

“…A recently published study looked at the relative impacts of a number of common health conditions on health and capability wellbeing [17]. It concluded that changing the evaluative space from a health-focused metric, such as the EQ-5D-5L, to one focused on capability wellbeing, such as the ICECAP measure for adults (ICECAP-A), could have a significant impact on funding priorities, and this was likely to positively affect the case for mental health conditions.…”