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

Månsdotter, Anna; Ekman, Björn; Feldman, Inna; Hagberg, Lars; Hurtig, Anna Karin; Lindholm, Lars

doi:10.1007/s40258-017-0323-0

Cited by 13 publications

(10 citation statements)

References 18 publications

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“…This lack of consensus about the use of capability instruments in decision making relates to the different approaches taken by different research groups to valuation, which means that in practice these measures are not comparable along the lines of a QALY. The idea of CALYs has been proposed by Mansdotter et al [47] who highlights the following issues. First, it is questionable which capabilities are able to explain differences in well-being and are sensitive to public policies in high-income countries.…”

Section: Applied Economic Evaluations and Potential Methods To Incorpmentioning

confidence: 99%

Capability instruments in economic evaluations of health-related interventions: a comparative review of the literature

et al. 2019

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Purpose Given increasing interest in using the capability approach for health economic evaluations and a growing literature, this paper aims to synthesise current information about the characteristics of capability instruments and their application in health economic evaluations. Methods A systematic literature review was conducted to assess studies that contained information on the development, psychometric properties and valuation of capability instruments, or their application in economic evaluations. Results The review identified 98 studies and 14 instruments for inclusion. There is some evidence on the psychometric properties of most instruments. Most papers found moderate-to-high correlation between health and capability measures, ranging between 0.41 and 0.64. ASCOT, ICECAP-A,-O and-SCM instruments have published valuation sets, most frequently developed using best-worst scaling. Thirteen instruments were originally developed in English and one in Portuguese; however, some translations to other languages are available. Ten economic evaluations using capability instruments were identified. The presentation of results show a lack of consensus regarding the most appropriate way to use capability instruments in economic evaluations with discussion about capability-adjusted life years (CALYs), years of capability equivalence and the trade-off between maximisation of capability versus sufficient capability. Conclusion There has been increasing interest in applying the capability-based approach in health economic evaluations, but methodological and conceptual issues remain. There is still a need for direct comparison of the different capability instruments and for clear guidance on when and how they should be used in economic evaluations.

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Section: Applied Economic Evaluations and Potential Methods To Incorpmentioning

confidence: 99%

Capability instruments in economic evaluations of health-related interventions: a comparative review of the literature

et al. 2019

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“…Nevertheless, there is a fair amount of research interest and funding for alternatives seeking to include well-being in addition to health. 12,[34][35][36][37][38] Aside from their theoretical merit, the combination of data needs and methods development required for many of these alternatives suggests Note. For the equity weighting based on baseline utility, we centered the scale with a weight of 1 to the mean utility for patients with chronic disease in the United States.…”

Section: Discussionmentioning

confidence: 99%

Alternative Approaches to Quality-Adjusted Life-Year Estimation Within Standard Cost-Effectiveness Models: Literature Review, Feasibility Assessment, and Impact Evaluation

et al. 2020

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The quality-adjusted life-year (QALY) has been long debated, but alternative estimation approaches have not been comprehensively evaluated. Our objective was to identify alternatives, characterize them by implementation feasibility, and evaluate the impact of implementing feasible options in cost-effectiveness models developed for the Institute for Clinical and Economic Review reports.Methods: We conducted a literature review combining keywords relating to QALYs, methodology alternatives, and costeffectiveness in PubMed, EconLit, Web of Science, and MEDLINE. Articles that discussed alternatives to the conventional QALY were included. Alternatives were characterized by type, data availability, calculation burden, and overall implementation feasibility. The subset of feasible alternatives, that is, sufficient data and methodology compatible with incorporation into common modeling approaches, were evaluated according to impact on incremental QALYs, incremental net monetary benefit (iNMB), intervention rankings, and proportion of interventions with a positive iNMB.Results: We identified 28 articles discussing 9 alternatives. Feasible alternatives were using patient preference (PP) data; equity weighting according to baseline utility, fair innings, or proportional QALY shortfall; and the equal value of life-yearsgained approach. All alternatives affected the incremental QALY and iNMB outcomes, rankings, and proportion of interventions with a positive iNMB. The PP alternative had the largest and most consistent impact. The PP impact on the proportion of interventions with a positive iNMB, was in the negative direction.Conclusions: Our work is the first comprehensive evaluation of proposed alternatives to the conventional QALY. We found robust literature but few options that were feasible to be implemented in current healthcare decision-making processes.

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“…The expansion of the QALY to incorporate outcomes beyond health has been gaining interest in recent years, with the development of preference-based measures such as ASCOT, 25 which assesses the impact of interventions in social care for a ''social-care related QALY''. Interest has also been raised in the development of a capability-adjusted life year 26 and the development of a broader quality of life measure describing functioning and well-being; this option is being explored in the E-QALY project being undertaken by several of the authors (DR, JC, JB). 27 However, broadening the scope of the QALY beyond health raises issues of comparability with QALYs that capture health alone.…”

Section: Discussionmentioning

confidence: 99%

Estimating a Preference-Based Single Index Measuring the Quality-of-Life Impact of Self-Management for Diabetes

et al. 2018

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Methods: A large online survey was conducted using a discrete choice experiment (DCE) with duration as an additional attribute on members of the UK general population (n=1,493) to elicit values for health (social limitations, mood, vitality, hypoglycaemia) and non-health (stress, hassle, control, support) aspects of selfmanagement in diabetes. The data was modelled using a conditional fixed-effects logit model and utility estimates were anchored on the 1-0 full health-dead scale. Results:The model produced significant and consistent coefficients, with one logical inconsistency and three insignificant coefficients for the milder levels of some attributes. The anchored utilities range from 1 for the best state to -0.029 for the worst state (meaning worse than dead) defined by the classification system. Conclusion:The results presented here can potentially be used to generate utility values capturing the day to day impact of interventions in diabetes on both health and self-management. These utility values can potentially be used to generate QALYs for use in economic models of the cost-effectiveness of interventions in diabetes.

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

Cited by 13 publications

References 18 publications

Capability instruments in economic evaluations of health-related interventions: a comparative review of the literature

Capability instruments in economic evaluations of health-related interventions: a comparative review of the literature

Alternative Approaches to Quality-Adjusted Life-Year Estimation Within Standard Cost-Effectiveness Models: Literature Review, Feasibility Assessment, and Impact Evaluation

Estimating a Preference-Based Single Index Measuring the Quality-of-Life Impact of Self-Management for Diabetes

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