Developing a broader measure for economic evaluation
Lead Research Organisation:
University of Birmingham
Department Name: Health Service Management Centre
Abstract
We aim to develop a new measure that looks at all aspects of quality of life, not just health, and can be used to assess value for money (cost-effectiveness). Such a measure will be important for estimating the cost-effectiveness of health interventions that impact on quality of life generally.
The National Health Service has a set amount of money to spend on providing services. Because of this it has to decide which services to provide and which services not to provide. Many of these decisions are made by thinking about whether the amount of money spent is worth the extra health that is achieved. For some services, especially public health interventions, looking just at health is problematic because these services do not just affect people’s health. For example, teenage pregnancy services might result in better education and life opportunities.
This new measure for use in cost-effectiveness studies will be developed by talking to people to find out what is important to them and why. The resulting important aspect of people’s lives will then be valued using survey techniques. These values can then be used in assessments of cost-effectiveness.
The National Health Service has a set amount of money to spend on providing services. Because of this it has to decide which services to provide and which services not to provide. Many of these decisions are made by thinking about whether the amount of money spent is worth the extra health that is achieved. For some services, especially public health interventions, looking just at health is problematic because these services do not just affect people’s health. For example, teenage pregnancy services might result in better education and life opportunities.
This new measure for use in cost-effectiveness studies will be developed by talking to people to find out what is important to them and why. The resulting important aspect of people’s lives will then be valued using survey techniques. These values can then be used in assessments of cost-effectiveness.
Technical Summary
Economic evaluation requires monetary measures or a single outcome for use across all interventions to assist decisions about service provision or technology adoption. The quality-adjusted life-year (QALY) has become the dominant measure for use in economic evaluation. Interventions such as public health, mental health and complex interventions, however, are not well served by this measure as they may impact broadly on quality of life rather than health per se. Economic evaluation for such interventions thus requires assessments of outcome going beyond the narrow health confines whilst still being amenable for use within economic evaluation.
Work on the MRC HSRC programme Investigating Choice Experiments for Preferences of Older People (ICEPOP) has successfully developed ? through extensive qualitative work and subsequent links with Amartya Sen?s capability theory ? a more general quality of life index that could potentially be used for such interventions. This measure is being used in intervention studies but it has been developed for use in older people and is not directly applicable to younger populations. This proposal seeks to develop and extend this capability measure for use across the entire adult population.
The research will take place in four phases. The first phase will use in-depth interviews with up to 40 informants to explore whether the attributes derived from older people are applicable to the adult population and to define conceptual attributes for an adult population. The second phase will use repeat semi-structured interviews with up to 25 informants to develop meaningful terminology for an adult population. The third phase will use interviewer administered best-worst scaling discrete choice experiments with 400 respondents to obtain values representing the importance of these attributes from an adult population. The final phase will explore the validity and reliability of the measure.
Iterative constant-comparative methods will be used to analyse all qualitative data. Discrete choice experiments will be analysed using regression techniques.
Work on the MRC HSRC programme Investigating Choice Experiments for Preferences of Older People (ICEPOP) has successfully developed ? through extensive qualitative work and subsequent links with Amartya Sen?s capability theory ? a more general quality of life index that could potentially be used for such interventions. This measure is being used in intervention studies but it has been developed for use in older people and is not directly applicable to younger populations. This proposal seeks to develop and extend this capability measure for use across the entire adult population.
The research will take place in four phases. The first phase will use in-depth interviews with up to 40 informants to explore whether the attributes derived from older people are applicable to the adult population and to define conceptual attributes for an adult population. The second phase will use repeat semi-structured interviews with up to 25 informants to develop meaningful terminology for an adult population. The third phase will use interviewer administered best-worst scaling discrete choice experiments with 400 respondents to obtain values representing the importance of these attributes from an adult population. The final phase will explore the validity and reliability of the measure.
Iterative constant-comparative methods will be used to analyse all qualitative data. Discrete choice experiments will be analysed using regression techniques.