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

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  • Ilias Goranitis
  • Joanna Coast
  • Ed Day
  • Alex Copello
  • Nick Freemantle
  • Emma Frew

Abstract

Conventional practice within the United Kingdom and beyond is to conduct economic evaluations with “health†as evaluative space and “health maximization†as the decision-making rule. However, there is increasing recognition that this evaluative framework may not always be appropriate, and this is particularly the case within public health and social care contexts. This article presents a methodological case study designed to explore the impact of changing the evaluative space within an economic evaluation from health to capability well-being and the decision-making rule from health maximization to the maximization of sufficient capability. Capability well-being is an evaluative space grounded on Amartya Sen’s capability approach and assesses well-being based on individuals’ ability to do and be the things they value in life. Sufficient capability is an egalitarian approach to decision making that aims to ensure everyone in society achieves a normatively sufficient level of capability well-being. The case study is treatment for drug addiction, and the cost-effectiveness of 2 psychological interventions relative to usual care is assessed using data from a pilot trial. Analyses are undertaken from a health care and a government perspective. For the purpose of the study, quality-adjusted life years (measured using the EQ-5D-5L) and years of full capability equivalent and years of sufficient capability equivalent (both measured using the ICECAP-A [ICEpop CAPability measure for Adults]) are estimated. The study concludes that different evaluative spaces and decision-making rules have the potential to offer opposing treatment recommendations. The implications for policy makers are discussed.

Suggested Citation

  • Ilias Goranitis & Joanna Coast & Ed Day & Alex Copello & Nick Freemantle & Emma Frew, 2017. "Maximizing Health or Sufficient Capability in Economic Evaluation? A Methodological Experiment of Treatment for Drug Addiction," Medical Decision Making, , vol. 37(5), pages 498-511, July.
    • Handle: RePEc:sae:medema:v:37:y:2017:i:5:p:498-511
    DOI: 10.1177/0272989X16678844
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    References listed on IDEAS

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    1. Kaspar Walter Meili & Anna Månsdotter & Linda Richter Sundberg & Jan Hjelte & Lars Lindholm, 2022. "An initiative to develop capability-adjusted life years in Sweden (CALY-SWE): Selecting capabilities with a Delphi panel and developing the questionnaire," PLOS ONE, Public Library of Science, vol. 17(2), pages 1-21, February.
    2. Lidia Engel & Stirling Bryan & David G. T. Whitehurst, 2021. "Conceptualising ‘Benefits Beyond Health’ in the Context of the Quality-Adjusted Life-Year: A Critical Interpretive Synthesis," PharmacoEconomics, Springer, vol. 39(12), pages 1383-1395, December.
    3. Kinghorn, Philip & Afentou, Nafsika, 2021. "Eliciting a monetary threshold for a year of sufficient capability to inform resource allocation decisions in public health and social care," Social Science & Medicine, Elsevier, vol. 279(C).
    4. Francesco Ramponi & Simon Walker & Susan Griffin & Steve Parrott & Colin Drummond & Paolo Deluca & Simon Coulton & Mona Kanaan & Gerry Richardson, 2021. "Cost‐effectiveness analysis of public health interventions with impacts on health and criminal justice: An applied cross‐sectoral analysis of an alcohol misuse intervention," Health Economics, John Wiley & Sons, Ltd., vol. 30(5), pages 972-988, May.
    5. Fattore, Giovanni & Federici, Carlo & Drummond, Michael & Mazzocchi, Mario & Detzel, Patrick & Hutton, Zsuzsa V & Shankar, Bhavani, 2021. "Economic evaluation of nutrition interventions: Does one size fit all?," Health Policy, Elsevier, vol. 125(9), pages 1238-1246.
    6. Petra Baji & Miklós Farkas & Ágota Dobos & Zsombor Zrubka & Levente Kovács & László Gulácsi & Márta Péntek, 2021. "Comparing the measurement properties of the ICECAP-A and ICECAP-O instruments in ages 50–70: a cross-sectional study on a representative sample of the Hungarian general population," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(9), pages 1453-1466, December.

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