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


  • Katherine Payne
  • Marion McAllister
  • Linda M. Davies


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

    1. Payne, Katherine & Nicholls, Stuart G. & McAllister, Marion & MacLeod, Rhona & Ellis, Ian & Donnai, Dian & Davies, Linda M., 2007. "Outcome measures for clinical genetics services: A comparison of genetics healthcare professionals and patients' views," Health Policy, Elsevier, vol. 84(1), pages 112-122, November.
    2. Karl Claxton & Mark Sculpher & Tony Culyer, 2007. "Mark versus Luke? Appropriate Methods for the Evaluation of Public Health Interventions," Working Papers 031cherp, Centre for Health Economics, University of York.
    3. Dolan, Paul, 2008. "Developing methods that really do value the ‘Q’ in the QALY," Health Economics, Policy and Law, Cambridge University Press, vol. 3(1), pages 69-77, January.
    4. Mooney, Gavin & Lange, Mette, 1993. "Ante-natal screening: What constitutes 'benefit'?," Social Science & Medicine, Elsevier, vol. 37(7), pages 873-878, October.
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    6. Rogowski, Wolf, 2007. "Current impact of gene technology on healthcare: A map of economic assessments," Health Policy, Elsevier, vol. 80(2), pages 340-357, February.
    7. Mooney, Gavin, 1994. "Editorial : What else do we want from our health services?," Social Science & Medicine, Elsevier, vol. 39(2), pages 151-154, July.
    8. Katherine Payne, 2009. "Fish and chips all round? Regulation of DNA‐based genetic diagnostics," Health Economics, John Wiley & Sons, Ltd., vol. 18(11), pages 1233-1236, November.
    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.
    11. Donaldson, Cam & Shackley, Phil, 1997. "Does "process utility" exist? A case study of willingness to pay for laparoscopic cholecystectomy," Social Science & Medicine, Elsevier, vol. 44(5), pages 699-707, March.
    12. Coast, Joanna & Flynn, Terry N. & Natarajan, Lucy & Sproston, Kerry & Lewis, Jane & Louviere, Jordan J. & Peters, Tim J., 2008. "Valuing the ICECAP capability index for older people," Social Science & Medicine, Elsevier, vol. 67(5), pages 874-882, September.
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    Blog mentions

    As found by, the blog aggregator for Economics research:
    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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    Cited by:

    1. 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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