title: Maximizing Health or Sufficient Capability in Economic Evaluation? A Methodological Experiment of Treatment for Drug Addiction.
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.
authors.affiliation: Health Economics Unit, Institute of Applied Health Research, University of Birmingham, UK (IG, EF).
authors.forename: Ilias
authors.initials: I
authors.lastname: Goranitis
authors.affiliation: School of Social and Community Medicine, University of Bristol, UK (JC).
authors.forename: Joanna
authors.initials: J
authors.lastname: Coast
authors.affiliation: Birmingham & Solihull Mental Health Foundation Trust, Research & Innovation Department, UK (ED, AC).|Addictions Department, National Addiction Centre, London, UK (ED).
authors.forename: Ed
authors.initials: E
authors.lastname: Day
authors.affiliation: Birmingham & Solihull Mental Health Foundation Trust, Research & Innovation Department, UK (ED, AC).|School of Psychology, University of Birmingham, UK (AC).
authors.forename: Alex
authors.initials: A
authors.lastname: Copello
authors.affiliation: Department of Primary Care and Population Health, University College London, UK (NF).
authors.forename: Nick
authors.initials: N
authors.lastname: Freemantle
authors.affiliation: Health Economics Unit, Institute of Applied Health Research, University of Birmingham, UK (IG, EF).
authors.forename: Emma
authors.initials: E
authors.lastname: Frew
mesh_terms: D004467:Economics; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D012046:Rehabilitation / Q000191:economics*; D019966:Substance-Related Disorders / Q000628:therapy*
keywords: ICECAP; capability; economic evaluation; health maximization; well-being