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Tapager I, Joensen LE, Vrangbæk K. The role of self-efficacy, well-being capability and diabetes care assessment for emotional and diabetes management challenges during the COVID-19 pandemic: Findings from a follow-up study. Soc Sci Med 2022; 310:115276. [PMID: 36063674 PMCID: PMC9395231 DOI: 10.1016/j.socscimed.2022.115276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/26/2022] [Accepted: 08/08/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Ina Tapager
- Department of Public Health, University of Copenhagen, Denmark.
| | | | - Karsten Vrangbæk
- Department of Public Health, University of Copenhagen, Denmark; Department of Political Science, University of Copenhagen, Denmark
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Meili KW, Månsdotter A, Sundberg LR, Hjelte J, Lindholm L. An initiative to develop capability-adjusted life years in Sweden (CALY-SWE): Selecting capabilities with a Delphi panel and developing the questionnaire. PLoS One 2022; 17:e0263231. [PMID: 35134053 PMCID: PMC8824323 DOI: 10.1371/journal.pone.0263231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 01/13/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Capability-adjusted life years Sweden (CALY-SWE) are a new Swedish questionnaire-based measure for quality of life based on the capability approach. CALY-SWE are targeted towards use in cost-effectiveness evaluations of social welfare consequences. Here, we first motivate the measure both from a theoretical and from a Swedish policy-making perspective. Then, we outline the core principles of the measure, namely the relation to the capability approach, embedded equity considerations inspired by the fair-innings approach, and the bases for which capabilities should be considered. The aims were to 1) the most vital capabilities for individuals in Sweden, 2) to define a sufficient level of each identified capability to lead a flourishing life, and to 3) develop a complete questionnaire for the measurement of the identified capabilities. Material and methods For the selection of capabilities, we used a Delphi process with Swedish civil society representants. To inform the questionnaire development, we conducted a web survey in three versions, with each Swedish 500 participants, to assess the distribution of capabilities that resulted from the Delphi process in the Swedish population. Each version was formulated with different strictness so that less strict wordings of a capability level would apply to a larger share of participants. All versions also included questions on inequality aversion regarding financial, educational, and health capabilities. Results The Delphi process resulted in the following six capabilities: Financial situation & housing, health, social relations, occupations, security, and political & civil rights. We formulated the final phrasing for the questionnaire based on normative reasons and the distribution of capabilities in the population while taking into account inequality aversion. Conclusion We developed a capability-based model for cost effectiveness economic evaluations of broader social consequences, specific to the Swedish context.
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Affiliation(s)
- Kaspar Walter Meili
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- * E-mail:
| | - Anna Månsdotter
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Department of Living Conditions and Lifestyles, Public Health Agency Public Health Agency of Sweden, Stockholm, Sweden
| | | | - Jan Hjelte
- Department of Social Work, Umeå University, Umeå, Sweden
| | - Lars Lindholm
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Farkas M, Huynh E, Gulácsi L, Zrubka Z, Dobos Á, Kovács L, Baji P, Péntek M. Development of Population Tariffs for the ICECAP-A Instrument for Hungary and their Comparison With the UK Tariffs. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1845-1852. [PMID: 34838283 DOI: 10.1016/j.jval.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The ICEpop CAPability measure for Adults (ICECAP-A) was developed to assess the capability well-being of adults for use in economic evaluations. Currently, ICECAP-A tariffs are available only for the UK population. The objectives of this study were to develop a Hungarian tariff set for the ICECAP-A instrument and to explore intercountry differences between the Hungarian and the UK value sets. METHODS A survey was conducted by computer-assisted personal interviews on a sample representative of the Hungarian adult population (N = 1000) to elicit their preferences regarding ICECAP-A attributes with the use of a best-worst scaling choice task. A latent class multinomial logit model with continuous variance scale was used to estimate the weights for each of the 4 capability levels of all 5 ICECAP-A attributes, namely, attachment, stability, achievement, enjoyment, and autonomy. RESULTS The model identified 2 preference classes with approximately equal share. The first class had a stronger relative preference for autonomy and achievement, whereas the second class had a strong preference for attachment. Multivariate analysis of the classes revealed that women, pensioners, people who are married or living in a partnership, and people with poorer health status are characteristics associated with the latter class membership (preference for attachment). Population tariffs were estimated from the model. Overall, attachment was found to be the most important attribute, followed by stability, enjoyment, achievement, and autonomy. CONCLUSIONS Hungarian tariffs are largely consistent with those found for the United Kingdom; nevertheless, autonomy seems to be less important in Hungary compared with the United Kingdom.
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Affiliation(s)
- Miklós Farkas
- School of Accounting and Finance, University of Bristol, Bristol, England, UK
| | - Elisabeth Huynh
- Department of Health Services Research and Policy, Research School of Population Health, Australian National University, Acton, Australia
| | - László Gulácsi
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary; Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | - Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary; Corvinus Institute for Advanced Studies, Corvinus University of Budapest, Budapest, Hungary
| | - Ágota Dobos
- Corvinus Center for Foreign Language Education and Research, Corvinus University of Budapest, Budapest, Hungary
| | - Levente Kovács
- Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.
| | - Márta Péntek
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
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Mitchell PM, Husbands S, Byford S, Kinghorn P, Bailey C, Peters TJ, Coast J. Challenges in developing capability measures for children and young people for use in the economic evaluation of health and care interventions. HEALTH ECONOMICS 2021; 30:1990-2003. [PMID: 34036671 PMCID: PMC7614859 DOI: 10.1002/hec.4363] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 05/13/2021] [Accepted: 05/14/2021] [Indexed: 05/26/2023]
Abstract
Methods for measuring outcomes suitable for economic evaluations of health and care interventions have primarily focused on adults. The validity of such methods for children and young people is questionable in areas including the outcome domains measured and how they are measured and valued, with most existing measures narrowly focusing on health. Novel methods for assessing benefits beyond health by focusing on a person's capability have also concentrated on adults to date. This paper aims to set out the rationale for capability measures in children and young people. It argues for the need to expand the evaluative space beyond health functioning towards broader capabilities, with children and young people playing an integral role in capability measure development. Drawing from existing literature, specific challenges related to the identification, measurement, and valuation of capabilities in children and young people are also discussed. Finally, the practical implications for conducting economic evaluation when measuring and valuing capabilities at different stages across the life-course are illustrated. We develop an alternative framework based on conceiving capabilities as evolving across the life-course. This framework may also be helpful in thinking about how to model health outcomes across the life-course.
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Affiliation(s)
- Paul Mark Mitchell
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Samantha Husbands
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sarah Byford
- King's Health Economics (KHE), Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Philip Kinghorn
- Health Economics Unit (HEU), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Cara Bailey
- School of Nursing, Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Tim J Peters
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna Coast
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Coast J, Bailey C, Canaway A, Kinghorn P. "It is not a scientific number it is just a feeling": Populating a multi-dimensional end-of-life decision framework using deliberative methods. HEALTH ECONOMICS 2021; 30:1033-1049. [PMID: 33647181 PMCID: PMC8129721 DOI: 10.1002/hec.4239] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 08/28/2020] [Accepted: 12/11/2020] [Indexed: 06/12/2023]
Abstract
The capability approach is potentially valuable for economic evaluation at the end of life because of its conceptualization of wellbeing as freedom and the potential for capturing outcomes for those at end of life and those close to persons at the end of life. For decision making, however, this information needs to be integrated into current evaluation paradigms. This research explored weights for an integrated economic evaluation framework using a deliberative approach. Twelve focus groups were held (38 members of the public, 29 "policy makers," seven hospice volunteers); budget pie tasks were completed to generate weights. Constant comparison was used to analyze qualitative data, exploring principles behind individuals' weightings. Average weights elicited from members of the general population and policy makers for the importance that should be given to close persons (vs. patients) were very similar, at around 30%. A "sliding scale" of weights between health gain and the capability for a good death resulted from the policy maker and volunteer groups, with increasing weight given to the capability for a good death as the trajectory got closer to death. These weights can be used in developing a more comprehensive framework for economic evaluation at end of life.
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Affiliation(s)
- Joanna Coast
- Health Economics BristolPopulation Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Cara Bailey
- School of NursingInstitute of Clinical SciencesUniversity of BirminghamBirminghamUK
| | - Alastair Canaway
- Warwick Clinical TrialsWarwick Medical SchoolUniversity of WarwickWarwickUK
| | - Philip Kinghorn
- Health Economics UnitInstitute of Applied Health ResearchUniversity of BirminghamBirminghamUK
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Kinghorn P, Afentou N. Eliciting a monetary threshold for a year of sufficient capability to inform resource allocation decisions in public health and social care. Soc Sci Med 2021; 279:113977. [PMID: 33964588 DOI: 10.1016/j.socscimed.2021.113977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/02/2021] [Accepted: 04/26/2021] [Indexed: 11/19/2022]
Abstract
AIM To elicit a deliberative monetary value for a year of sufficient capability well-being (YSC) and a year of full capability (YFC), to inform decision-making in the contexts of social care and public health. METHODS 69 members of the public, recruited from purposively selected electoral wards across the West Midlands Region of England, attended one of six deliberative workshops in 2017. Participants were informed about the nature of public health and social care, and the funding of these services by local authorities. Participants were then asked to report: their willingness to pay additional tax (ring-fenced for social care/public health services); and the maximum amount they would be willing to allocate for social care/public health services from an existing local authority budget. In both cases they were asked to assume that the funding would result in improved well-being equivalent to a YSC. The second task was repeated for improved well-being equivalent to a YFC. Representatives from the six initial workshops reconvened at a consensus workshop to arrive at a final arbitrated value for a YSC and YFC. RESULTS Mean values elicited during the initial workshops increased after discussion (from £442 to £451 in the case of WTP additional tax). Almost half of participants changed their response post-discussion when reporting a societal (aggregated) WTP. The arbitrated value of a YSC was £33,500, with a range of £33,500 to £36,150 emerging as the value of a YFC. DISCUSSION This is the first study to use a deliberative approach to elicit a monetary threshold for an additional YSC/YFC. Qualitative research supports the validity of responses to the taxation question. Deliberation appears to have influenced the societal (aggregated) values reported by participants. CONCLUSION Future research should explore the robustness of a monetary threshold of £33,500 for a YSC.
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Affiliation(s)
- Philip Kinghorn
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, United Kingdom.
| | - Nafsika Afentou
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, United Kingdom
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Mitchell PM, Husbands S, Sanghera S, Caskey FJ, Scott J, Coast J. Measuring capability wellbeing in adults at different stages of life for use in economic evaluation of health and care interventions: a qualitative investigation in people requiring kidney care. Qual Life Res 2021; 30:2863-2873. [PMID: 33973109 PMCID: PMC8481176 DOI: 10.1007/s11136-021-02851-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Capability wellbeing measures, such as the ICECAP measures, have been proposed for use in economic evaluations to capture broader outcomes of health and care interventions. The ICECAP measures have been developed to reflect capabilities at different stages of life. Some patient groups include patients of different ages and at different stages of life, so it is not always apparent which ICECAP measure is most relevant. This study explores the impact of age and life stage on completion, where both ICECAP-A and ICECAP-O were completed by the same patient. METHODS A think-aloud study, and an associated semi-structured interview were conducted with people receiving kidney care as a renal outpatient, kidney transplant outpatient, or through receiving facility-based haemodialysis. Qualitative analysis focused on (1) differences in responses across measures by individuals, where attributes had conceptual overlap, (2) key factors in self-reported capability levels, and (3) measure preference. RESULTS Thirty participants were included in the study, with a mix of older and younger adults. Attributes with similar wording across measures produced similar responses compared to attributes where wording differed. Age and health were key factors for self-reported capability levels. ICECAP-A was slightly preferred overall, including by older adults. CONCLUSION This study suggests use of ICECAP-A in patients with certain chronic health conditions that include a mix of adults across the life course. This study highlights the importance of considering the stage of life when using capability measures and in economic evaluations of health and care interventions more generally.
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Affiliation(s)
- Paul Mark Mitchell
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Samantha Husbands
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sabina Sanghera
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Fergus John Caskey
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK ,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jemima Scott
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK ,Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Joanna Coast
- Health Economics Bristol (HEB), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Himmler S, van Exel J, Brouwer W. Estimating the monetary value of health and capability well-being applying the well-being valuation approach. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1235-1244. [PMID: 32939595 PMCID: PMC7561589 DOI: 10.1007/s10198-020-01231-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 08/26/2020] [Indexed: 05/08/2023]
Abstract
BACKGROUND Quality of life measures going beyond health, like the ICECAP-A, are gaining importance in health technology assessment. The assessment of the monetary value of gains in this broader quality of life is needed to use these measurements in a cost-effectiveness framework. METHODS We applied the well-being valuation approach to calculate a first monetary value for capability well-being in comparison to health, derived by ICECAP-A and EQ-5D-5L, respectively. Data from an online survey administered in February 2018 to a representative sample of UK citizens aged 18-65 was used (N = 1512). To overcome the endogeneity of income, we applied an instrumental variable regression. Several alternative model specifications were calculated to test the robustness of the results. RESULTS The base case empirical estimate for the implied monetary value of a year in full capability well-being was £66,597. The estimate of the monetary value of a QALY, obtained from the same sample and using the same methodology amounted to £30,786, which compares well to previous estimates from the willingness to pay literature. Throughout the conducted robustness checks, the value of capability well-being was found to be between 1.7 and 2.6 times larger than the value of health. CONCLUSION While the applied approach is not without limitations, the generated insights, especially concerning the relative magnitude of valuations, may be useful for decision-makers having to decide based on economic evaluations using the ICECAP-A measure or, to a lesser extent, other (capability) well-being outcome measures.
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Affiliation(s)
- Sebastian Himmler
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Werner Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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9
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Péntek M, van Exel J, Gulácsi L, Brodszky V, Zrubka Z, Baji P, Rencz F, Brouwer WBF. Acceptable health and ageing: results of a cross-sectional study from Hungary. Health Qual Life Outcomes 2020; 18:346. [PMID: 33081803 PMCID: PMC7574437 DOI: 10.1186/s12955-020-01568-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 09/18/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to investigate the acceptability of imperfect health states in relation to age in Hungary and analyse its determinants. Results are contrasted to age-matched actual population health scores and to findings from a previous study in The Netherlands. METHODS A cross-sectional online survey was performed. The same survey questions were applied as in a previous study in The Netherlands in order to enable inter-country comparisons. The descriptive system of the EQ-5D-3L health status questionnaire was used to assess the acceptability of moderate and severe health problems at ages from 30 to 80 by 10-year age-groups. Descriptive statistics were performed and linear regression analysis was used to investigate the determinants of acceptability. RESULTS Altogether 9281 (female 32.8%) were involved with mean age 36.0 years and EQ-5D-3L index score of 0.852 (SD 0.177). Acceptability of health problems increased with age, differed per health domain and with severity of the problems. Except for 'Self-care', moderate health problems were acceptable by the majority from age 70 and acceptability scores were lower than EQ-5D-3L population norms from that age. The lowest average acceptability age was found in the 'Anxiety/depression' and dimension the highest in the 'Self-care' dimension. Respondents' age, current health, and lifestyle were significant determinants (R2: 0.041-0.130). With a few minor exceptions in some health dimensions, acceptability levels and patterns were strikingly similar to the Dutch findings. CONCLUSION In Hungary, acceptability of health problems increases with age and the majority found severe problems never acceptable. Views on acceptability of health problems seem to be fairly generalizable across European countries with different health and economic indicators.
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Affiliation(s)
- Márta Péntek
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle Building, Office J8-51, PO Box 1738, 3000 DR, Rotterdam, The Netherlands. .,Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - László Gulácsi
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Valentin Brodszky
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Zsombor Zrubka
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Petra Baji
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Fanni Rencz
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary.,Premium Postdoctoral Research Programme, Hungarian Academy of Sciences, Budapest, Hungary
| | - Werner B F Brouwer
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Bayle Building, Office J8-51, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.,Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
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10
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Mah C, Noonan VK, Bryan S, Whitehurst DGT. Empirical Validity of a Generic, Preference-Based Capability Wellbeing Instrument (ICECAP-A) in the Context of Spinal Cord Injury. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:223-240. [PMID: 32981008 DOI: 10.1007/s40271-020-00451-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Assessing the validity of generic instruments across different clinical contexts is an important area of methodological research in economic evaluation and outcomes measurement. OBJECTIVE Our objective was to examine the empirical validity of a generic, preference-based capability wellbeing instrument (ICECAP-A) in the context of spinal cord injury. METHODS This study consisted of a secondary analysis of data collected using an online cross-sectional survey. The survey included questions regarding demographics, injury classifications and characteristics, secondary health conditions, quality of life and wellbeing, and functioning in activities of daily living. Analysis comprised the descriptive assessment of Spearman's rank correlations between item-/dimension-level data for the ICECAP-A and four preference-based health-related quality of life (HRQoL) instruments, and discriminant and convergent validity approaches to examine 21 evidence-informed or theoretically derived constructs. Constructs were defined using participant and injury characteristics and responses to a range of health, wellbeing and functioning outcomes. RESULTS Three hundred sixty-four individuals completed the survey. Mean index score for the ICECAP-A was 0.761; 12 (3%) individuals reported full capability (upper anchor; score = 1), and there were no reports of zero capabilities (lower anchor; score = 0). The strongest correlations were dominated by items and dimensions on the comparator (HRQoL) instruments that are non-health aspects of quality of life, such as happiness and control over one's life (including self-care). Of 21 hypothesised constructs, 19 were confirmed in statistical tests, the exceptions being the exploratory hypotheses regarding education and age at injury. CONCLUSION The ICECAP-A is an empirically valid outcome measure for assessing capability wellbeing in people with spinal cord injury living in a community setting. The extent to which the ICECAP-A provides complementary information to preference-based HRQoL instruments is dependent on the comparator.
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Affiliation(s)
- Cassandra Mah
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, BC, Canada.,Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. .,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada. .,International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Kinghorn P, Afentou N. Proxy responses to ICECAP-A: Exploring variation across multiple proxy assessments of capability well-being for the same individuals. PLoS One 2020; 15:e0236584. [PMID: 32722698 PMCID: PMC7386591 DOI: 10.1371/journal.pone.0236584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 07/08/2020] [Indexed: 12/16/2022] Open
Abstract
Background The ICECAP capability measures are increasingly being used to capture the impact of health and social care interventions on well-being. In cases where the recipient of an intervention is highly vulnerable, proxy completion may be necessary. This study adds to the limited existing evidence on proxy completion of ICECAP-A specifically and adopts the novel approach of investigating multiple proxy responses for the same four (hypothetical) individuals. Methods 62 members of the public who were participating in a series of one day deliberative workshops on public health and social care completed ICECAP-A on behalf of four hypothetical individuals, described in vignettes. Quantitative analysis explored the range of proxy responses for each of the four hypothetical individuals, and any possible correlation between participants’ own characteristics and their proxy responses. Participants discussed their proxy responses after completing the task; this discussion was audio recorded and analysed using Framework Analysis. Results Wide variation in ICECAP-A scores was observed across proxy respondents for each hypothetical individual. Participants’ demographic characteristics and own well-being do not appear to have systematically influenced proxy responses. Qualitative analysis suggests two principal approaches (or perspectives) were adopted by participants: Empathetic (adopting the perspective of the ‘subject’) and factual (a factual assessment of the subject’s well-being). Participants also drew on their own experiences to varying degrees. There were differing interpretations of the Independence attribute on ICECAP-A and some evidence that participants’ ideas of what constituted achievement were context (including life-stage and condition/health) specific. Conclusions The factual versus empathetic approaches identified from qualitative analysis in this study match to the concept of a proxy-proxy versus proxy-patient perspective, previously outlined in the literature. Researchers should consider specifying which perspective proxy raters should adopt. Findings also suggest proxy responses can be influenced by external points of reference and interpretation of measure attributes.
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Affiliation(s)
- Philip Kinghorn
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Nafsika Afentou
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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12
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Afentou N, Kinghorn P. A Systematic Review of the Feasibility and Psychometric Properties of the ICEpop CAPability Measure for Adults and Its Use So Far in Economic Evaluation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:515-526. [PMID: 32327169 DOI: 10.1016/j.jval.2019.12.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/04/2019] [Accepted: 12/17/2019] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Development of the ICEpop CAPability measure for Adults (ICECAP-A) was reported in 2012; use of certain capability measures was suggested in the context of social or long-term care soon afterward by decision-making organizations in the United Kingdom and The Netherlands. Despite enthusiasm for the ICECAP-A, this study represents the first attempt to collate evidence on its psychometric properties and its use in economic analysis. METHODS A systematic review of studies published between January 2012 and February 2019 that have either explored the psychometric properties of the ICECAP-A (validity, reliability, and responsiveness) or report its use in economic analysis. RESULTS Twenty-seven studies were identified, 11 undertaking some form of economic analysis (including pilot and feasibility studies) and 16 assessing psychometric properties (7 assessing construct validity). The ICECAP-A has mainly been used in the United Kingdom, but also in other English-speaking countries and in Europe, across a wide range of healthcare contexts. There is promising evidence on content validity, construct validity, and responsiveness. Although there was consistently strong associations between the ICECAP-A and the Assessment of Quality of Life-Eight Dimension, associations with the EuroQol 5-dimension 3-level and EuroQol 5-dimension 5-level were inconsistent. In some cases, it was found that a switch in evaluative space from health to capability well-being would alter resource allocation decisions. CONCLUSION The ICECAP-A is correlated with health-related quality of life but is most appropriately regarded as a complement for and not a substitute to the EuroQol 5-dimension 3-level and EuroQol 5-dimension 5-level in particular. Positive evidence of the measure's content and construct validity is beginning to accumulate, but further conceptual and policy debate is needed regarding the equity implications of switching between evaluative spaces.
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Affiliation(s)
- Nafsika Afentou
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK
| | - Philip Kinghorn
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, UK.
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Clarke P, Erreygers G. Defining and measuring health poverty. Soc Sci Med 2020; 244:112633. [DOI: 10.1016/j.socscimed.2019.112633] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 10/16/2019] [Accepted: 10/18/2019] [Indexed: 11/29/2022]
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