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Valuing The Economic Benefits Of Complex Interventions: When Maximising Health Is Not Sufficient

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  • Katherine Payne
  • Marion McAllister
  • Linda M. Davies

Abstract

Complex interventions, involving interlinked packages of care, challenge the application of current methods of economic evaluation that focus on measuring only health gain. Complex interventions may be problematic on two levels. The complexity means the intervention may not fit into one of the current appraisal systems, and/or maximising health is not the only objective. This paper discusses the implications of a programme of work that focused on clinical genetics services, as an example of a complex intervention, and aimed to identify the following: the attributes that comprise both health and non‐health aspects of benefits and whether it is possible to evaluate such an intervention using current National Institute for Health and Clinical Excellence appraisal processes. Genetic services and tests are a good example of a complex intervention and have broader objectives than just health gain, which may usefully be measured using the concept related to capability, which we have called ‘empowerment’. Further methodological work is required to identify the trade‐off between non‐health (empowerment) and health benefits for other complex interventions. We do not advocate a move away from QALY maximisation but do suggest that there is a need for a more considered approach that can take account of the perceived value for non‐health attributes for some complex interventions. Copyright © 2012 John Wiley & Sons, Ltd.

Suggested Citation

  • Katherine Payne & Marion McAllister & Linda M. Davies, 2013. "Valuing The Economic Benefits Of Complex Interventions: When Maximising Health Is Not Sufficient," Health Economics, John Wiley & Sons, Ltd., vol. 22(3), pages 258-271, March.
  • Handle: RePEc:wly:hlthec:v:22:y:2013:i:3:p:258-271
    DOI: 10.1002/hec.2795
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    References listed on IDEAS

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    9. Stephen Birch & Joy Melnikow & Miriam Kuppermann, 2003. "Conservative versus aggressive follow up of mildly abnormal Pap smears: Testing for process utility," Health Economics, John Wiley & Sons, Ltd., vol. 12(10), pages 879-884, October.
    10. Joanna Coast & Richard Smith & Paula Lorgelly, 2008. "Should the capability approach be applied in Health Economics?," Health Economics, John Wiley & Sons, Ltd., vol. 17(6), pages 667-670, June.
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    Blog mentions

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    1. #HEJC for 04/03/2013
      by academichealtheconomists in The Academic Health Economists' Blog on 2013-02-26 05:24:40
    2. Thesis Thursday: Martin Eden
      by Chris Sampson in The Academic Health Economists' Blog on 2020-05-21 06:00:06

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    2. Helen Dakin & Alastair Gray, 2018. "Decision Making for Healthcare Resource Allocation: Joint v. Separate Decisions on Interacting Interventions," Medical Decision Making, , vol. 38(4), pages 476-486, May.
    3. Matthew Franklin & Katherine Payne & Rachel A. Elliott, 2018. "Quantifying the Relationship between Capability and Health in Older People: Can’t Map, Won’t Map," Medical Decision Making, , vol. 38(1), pages 79-94, January.
    4. Hill, Sarah R. & Vale, Luke & Hunter, David & Henderson, Emily & Oluboyede, Yemi, 2017. "Economic evaluations of alcohol prevention interventions: Is the evidence sufficient? A review of methodological challenges," Health Policy, Elsevier, vol. 121(12), pages 1249-1262.

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