Are Quality-Adjusted Life Years a Good Proxy Measure of Individual Capabilities?

Paul Mitchell*, Sridhar Venkatapuram, Jeff Richardson, Angelo Iezzi, Joanna Coast

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

10 Citations (Scopus)
320 Downloads (Pure)

Abstract

Background
There is a debate in the health economics literature concerning the most appropriate way of applying Amartya Sen’s capability approach in economic evaluation studies. Some suggest that quality-adjusted life years (QALYs) alone are adequate while others argue that this approach is too narrow and that direct measures of capability wellbeing provide a more extensive application of Sen’s paradigm.
Objective
This paper empirically explores whether QALYs provide a good proxy for individual capabilities.
Methods
Data is taken from a multinational cross-sectional survey of individuals with seven health conditions (asthma, arthritis, cancer, depression, diabetes, hearing loss, heart disease) and a healthy population. Each individual completed the ICECAP-A measure of capability wellbeing for adults and six health utility instruments that are used to generate QALYs, including EQ-5D and SF-6D. Primary analysis examines how well health utility instruments can explain variation in the ICECAP-A using ordinary least squares regression.
Results
The findings show that all seven health conditions have a negative association on overall capability as measured by the ICECAP-A index. Inclusion of health utility instruments into separate regressions improves the predictive power of capability but on average, explains less than half of the variation in capability wellbeing. Individuals with arthritis appear to be less inhibited in terms of capability losses when accounting for health utility, yet those who have depression record significant reductions in capability relative to the healthy population even after accounting for the most commonly used health utility instruments.
Conclusion
The study therefore casts doubt on the ability of QALYs to act as a reliable proxy measure of individuals’ capability.
Original languageEnglish
Pages (from-to)637-646
Number of pages10
JournalPharmacoEconomics
Volume35
Issue number6
Early online date25 Feb 2017
DOIs
Publication statusPublished - Jun 2017

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