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Purpose
A paper reporting the development of the ICECAP-O was published in 2006. Since then, there has been increasing interest in the use of capability-based measures within health economics and the ICECAP-O has been suggested for use in economic evaluation by decision-making bodies in the Netherlands and UK.
Methods
A systematic review of studie...
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Purpose:
Given increasing interest in using the capability approach for health economic evaluations and a growing literature, this paper aims to synthesise current information about the characteristics of capability instruments and their application in health economic evaluations.
Methods:
A systematic literature review was conducted to assess s...
Citations
... The focus group was conducted in person, in both English and French, respecting COVID restrictions for masking and social distancing. The focus group that appraised the value of existing were given 11 measures to discuss: SF-36 [30], EQ-5D [31], PROMIS-Global [32], PROMIS-29 [32], WHOQOL-BREF [33], PBMSI [34], ICECAP [35], EORTC [36], QOL Scale [37], CQolC [38], CDC-HRQL [39], OPQOL [40], AQOL [41], CASP-19 [42]. Four groups of 5 to 6 people were assembled, three groups of English speakers and one group of French speakers, although all were capable in both languages. ...
Aims
Many older persons do not think of themselves as “patients” but as persons wishing to live as actively as possible for as long as possible. However, most health-related quality of life (HRQL) measures were developed for use with clinical populations. The aim of this project was to fill that gap and to develop, for international use, a measure of what matters to older persons as they age and seek to remain as active as possible, Older Persons for Active Living (OPAL).
Methods
For content development, interviews about active living were conducted with older persons from Canada, USA, UK, and the Netherlands in English, French, Spanish and Dutch, respectively with subsequent thematic analysis and harmonization.
Results
Analyses of transcripts from 148 older persons revealed that active living was a “way of being” and not merely doing activities. Saturation was reached and a total of 59 content areas were identified. After grouping similar “ways” together and after conducting a consensus rating of importance, 19 unique and important “ways” remained. In some languages, formulating was challenging for three of the 19, resulting in changes to two English words and dropping two other words, yielding a final list of 17 “ways of being” with harmonized wording in 4 languages.
Conclusion
This study underscores the significance of listening to older adults and highlights the importance of considering linguistic and cultural nuances in measure development.
... An important outcome measure for care home residents is their QoL, which can be appropriately assessed using several measures. In terms of economic evaluation, it is ideal if these measures can be converted, along with knowledge of life expectancy, into quality-adjusted life years (QALYs), or an equivalent [2]. The most used measure of this kind is the EuroQol five-dimension questionnaire (EQ-5D), a measure of health-related quality of life [3]. ...
Background: To maintain good standards of care, evaluations of policy interventions or potential
improvements to care are required. A number of quality of life (QoL) measures could be used but
there is little evidence for England as to which measures would be appropriate. Using data from a
pilot Minimum Data Set (MDS) for care home residents from the Developing resources And
minimum dataset for Care Homes' Adoption (DACHA) study, we assessed the construct validity of
QoL measures and analysed factors associated with QoL. This was to demonstrate the value of the
pilot MDS data and to provide evidence for the inclusion of QoL measures in a future MDS.
Methods: Care home records for 679 residents aged over 65 from 34 care homes were available that
had been linked to health records and official care home provider data. In addition to data on
demographics, level of needs and impairment, several questions about the social care- and health-related QoL of participants were completed through proxy report (ASCOT proxy-resident, ICECAP-O, EQ5D-5D-5L Proxy 2). Construct validity was assessed through testing hypotheses developed from
previous research and QoL measure constructs using discriminant analysis. Multilevel regression
models were developed to understand how QoL was influenced by personal characteristics (e.g. sex,
levels of functional and cognitive ability), care home level factors (type of home, level of quality) and resident use of health services (potentially avoidable emergency hospital admissions). Multiple
imputation was used for missing data.
Results: All three measures were negatively associated with levels of cognitive impairment, whilst ICECAP-O and EQ-5D-5L Proxy 2 were negatively associated with low levels of functional ability. ASCOT Proxy-Resident was positively associated with aspects of quality and care effectiveness at both resident- and care home-level. All three QoL measures had acceptable construct validity and captured different aspects of QoL.
Conclusion: The study found acceptable construct validity for ASCOT-Proxy-Resident, ICECAP-O and
EQ-5D-5L Proxy 2 in care homes as complementary measures based on different constructs. The
study has demonstrated both the value of the DACHA study pilot MDS data and a rationale for the
inclusion of these QoL measures in any future MDS.
... The theory of the capability approach emphasizes the individual's ability and freedom to acquire objectives they value. Much like the frequently used ICEpop CAPability (ICECAP-A/O) capability measure for Adults/ Older and Adult Social Care Outcomes Toolkit (ASCOT) for social care outcomes, the OxCAP-MH was developed in the UK [15,16]. It has since five further language validations: German [17], Hungarian [18], Luganda [19], Juba Arabic, and Chinese. ...
... Item sum score ranges between 0 and 27. Originally, four severity categories were established: no (0-4), mild (5-9), moderate (10)(11)(12)(13)(14), severe (15)(16)(17)(18)(19), extremely severe depression (20)(21)(22)(23)(24)(25)(26)(27). Many studies investigated the cut-off score to signify severity of depression, commonly setting the sensitivity of the instrument as: non-depressed (score below 10) or depressed (score of 10 or more) [26][27][28][29]. ...
Aim
The study aims to establish the first set of normative data for OxCAP-MH capability instrument and to examine its association with sociodemographic and anxiety/depression severity variables.
Methods
A large-sample cross-sectional online survey was conducted among the Hungarian adult general population in 2021. OxCAP-MH standardized mean scores were compared across age, sex, education level, residence, employment, and marital status. Linear regression analysis was employed to determine the impact of sociodemographic and anxiety/depression severity on the OxCAP-MH score.
Results
In total, N = 2000 individuals completed the survey. The sample mean age was 47.1, with female majority (53.4%). Most respondents had completed primary education (51%), were active on labour market (52.4%), lived in larger cities (70.0%), and were married/in relationship (61.1%). Nearly half of the participants reported experiencing depression (48.5%), anxiety (44.3%), and 38.6% reported having both. The mean OxCAP-MH score for the total sample was 67.2 (SD = 14.4), the highest in the non-depressed (74.4) and non-anxious (73.6) subgroups, the lowest among those with extremely severe depression (45.0) and severe anxiety (47.7). Regression results indicated that older individuals (by β = 0.1), males (β = 2.3), those with secondary or higher education (β = 2.7 and 4.5) and students (β = 6.8) had significantly (p<0.01) higher mental capabilities. Respondents with mild, moderate, severe, or extremely severe depression (β = -6.6, -9.6, -13.8, -18.3) and those with mild, moderate, or severe anxiety (β = -4.1, -7.7, -10.3) had lower capability scores.
Conclusion
The OxCAP-MH instrument effectively differentiated capabilities across sociodemographic groups and highlighting the impact of depression and anxiety severity on general population’s mental capability.
... where a focus on physical functioning alone may provide an incomplete evaluation of the benefits of an intervention. 31 Concerns about falling will be measured using the short Falls Efficacy Scale-International, a high priority for patients following hip fracture. 25 28 It is valid and reliable in patients following hip fracture aged ≥65 years. ...
Introduction
Hip fractures result in substantial health impacts for patients and costs to health systems. Many patients require prolonged hospital stays and up to 60% do not regain their prefracture level of mobility within 1 year. Physical rehabilitation plays a key role in regaining physical function and independence; however, there are no recommendations regarding the optimal intensity. This study aims to compare the clinical efficacy and cost-effectiveness of early intensive in-hospital physiotherapy compared with usual care in patients who have had surgery following a hip fracture.
Methods and analysis
This two-arm randomised, controlled, assessor-blinded trial will recruit 620 participants who have had surgery following a hip fracture from eight hospitals. Participants will be randomised 1:1 to receive usual care (physiotherapy according to usual practice at the site) or intensive physiotherapy in the hospital over the first 7 days following surgery (two additional sessions per day, one delivered by a physiotherapist and the other by an allied health assistant). The primary outcome is the total hospital length of stay, measured from the date of hospital admission to the date of hospital discharge, including both acute and subacute hospital days. Secondary outcomes are functional mobility, health-related quality of life, concerns about falling, discharge destination, proportion of patients remaining in hospital at 30 days, return to preadmission mobility and residence at 120 days and adverse events. Twelve months of follow-up will capture data on healthcare utilisation. A cost-effectiveness evaluation will be undertaken, and a process evaluation will document barriers and facilitators to implementation.
Ethics and dissemination
The Alfred Hospital Ethics Committee has approved this protocol. The trial findings will be published in peer-reviewed journals, submitted for presentation at conferences and disseminated to patients and carers.
Trial registration number
ACTRN12622001442796.
... The primary outcome measure for the economic analysis will be quality-adjusted life year (QALYs) derived from utility scores, obtained from the EQ5D-5L instrument [25], and measured using the area-underthe-curve approach. Secondary economic outcomes will be Years of Full Capability (YFC), obtained from the ICECAP-O measure [26]. Both QALYs and YFC will be measured for the participants and volunteers. ...
Background
The Active Connected Engaged [ACE] study is a multi-centre, pragmatic, two-arm, parallel-group randomised controlled trial [RCT] with an internal pilot phase. The ACE study incorporates a multi-level mixed methods process evaluation including a systems mapping approach and an economic evaluation. ACE aims to test the effectiveness and cost-effectiveness of a peer-volunteer led active ageing intervention designed to support older adults at risk of mobility disability to become more physically and socially active within their communities and to reduce or reverse, the progression of functional limitations associated with ageing.
Methods/design
Community-dwelling, older adults aged 65 years and older (n = 515), at risk of mobility disability due to reduced lower limb physical functioning (Short Physical Performance Battery (SPPB) score of 4–9 inclusive) will be recruited. Participants will be randomised to receive either a minimal control intervention or ACE, a 6-month programme underpinned by behaviour change theory, whereby peer volunteers are paired with participants and offer them individually tailored support to engage them in local physical and social activities to improve lower limb mobility and increase their physical activity. Outcome data will be collected at baseline, 6, 12 and 18 months. The primary outcome analysis (difference in SPPB score at 18 months) will be undertaken blinded to group allocation. Primary comparative analyses will be on an intention-to-treat (ITT) basis with due emphasis placed on confidence intervals.
Discussion
ACE is the largest, pragmatic, community-based randomised controlled trial in the UK to target this high-risk segment of the older population by mobilising community resources (peer volunteers). A programme that can successfully engage this population in sufficient activity to improve strength, coordination, balance and social connections would have a major impact on sustaining health and independence.
ACE is also the first study of its kind to conduct a full economic and comprehensive process evaluation of this type of community-based intervention. If effective and cost-effective, the ACE intervention has strong potential to be implemented widely in the UK and elsewhere.
Trial registration
ISRCTN, ISRCTN17660493. Registered on 30 September 2021.
Trial Sponsor: University of Birmingham, Contact: Dr Birgit Whitman, Head of Research Governance and Integrity; Email: researchgovernance@contacts.bham.ac.uk.
Protocol Version 5 22/07/22.
... With respect to the ICER threshold based on the ICECAP, however, it should be recognized that there is currently no guidance on the criteria by which an intervention is considered cost-effective. 56 With that being said, some findings have been accumulated to date. One study, 53 which used a deliberative approach to elicit a monetary threshold for an additional year of sufficient capability, indicated that the value with majority support at the workshop was £33,500; however, for a year of full capability, no agreement could be reached on a single value, ranging from £33,500 to £36,150, which was half as large as the value of £66,597 drawn by Himmler et al 54 As such, while there remains a certain range in the threshold, this study results appeared to be costeffective compared to this threshold range of £33,500-66,597. ...
Purpose
This study aimed to conduct an economic evaluation of mindfulness-based cognitive therapy (MBCT) in healthy participants by performing cost-utility analysis (CUA) and cost-benefit analysis (CBA).
Patients and Methods
CUA was carried out from a healthcare sector perspective and CBA was from the employer’s perspective in parallel with a randomized controlled trial. Of the 90 healthy participants, 50 met the inclusion criteria and were randomized to the MBCT group (n = 25) or wait-list control group (n = 25). In the CUA, intervention costs and healthcare costs were included, while the mean difference in the change in quality-adjusted life years (QALYs) between the baseline and 16-week follow-up was used as an indicator of effect. Incremental cost-effectiveness ratio (ICER) was produced, and uncertainty was addressed using non-parametric bootstrapping with 5000 replications. In the CBA, the change in productivity losses was reflected as a benefit, while the costs included intervention and healthcare costs. The net monetary benefit was calculated, and uncertainty was handled with 5000 bootstrapping. Healthcare costs were measured with the self-report Health Service Use Inventory. The purchasing power parity in 2019 was used for currency conversion.
Results
In the CUA, incremental costs and QALYs were estimated at JPY 19,700 (USD 189) and 0.011, respectively. The ICER then became JPY 1,799,435 (USD 17,252). The probability of MBCT being cost-effective was 92.2% at the threshold of 30,000 UK pounds per QALY. The CBA revealed that MBCT resulted in increased costs (JPY 24,180) and improved work productivity (JPY 130,640), with a net monetary benefit of JPY 106,460 (USD 1021). The probability of the net monetary benefit being positive was 69.6%.
Conclusion
The results suggested that MBCT may be more cost-effective from a healthcare sector perspective and may be cost-beneficial from the employer’s perspective.
... To put this review in context, we wish to highlight two recent publications that provide excellent reviews of a number of capability measurement instruments (i.e. ICECAP, ASCOT, OCAP, OxCap, and ACQ-CMH) and their use in the context of economic evaluation (Helter et al. 2019;Proud, McLoughlin, and Kinghorn 2019). While these reviews consider health-related capability measurement instruments and their ability to capture the outcomes of value, our present review should be considered complementary to this health economic evaluation focused work. ...
Researchers seeking to assess the impact of a program on the capability of its target audience face numerous methodological challenges. The purpose of our review was to see to what extent such challenges are recognised and what choices researchers made in order to address them, and why. We identified 3354 studies by searching five databases in addition to cross-checking references from selected studies. A total of 71 studies met our pre-defined selection criteria: empirical studies reporting data on how interventions impacted the beneficiaries' capability, providing sufficient detail on how impact was measured, in English language. Four independent raters assessed those studies on four domains: descriptive information, consideration of causal attribution, operationalisation of capability, and interpretation of findings. Challenges related to capability impact assessment were not widely explicitly acknowledged, and available measures to address these challenges were not being used routinely. Major weaknesses included little attention to causal attribution, infrequent justification of the specific content of capability, and failure to research the constitutive elements of capability and their interactions. Research into a program's impact on the capability of its recipients is challenging for several reasons, but options are available to further improve the quality of this type of research.
... Although the capability concept appears quite congenial to the theory and practice of rehabilitation, its application to the field is still in its infancy. In the recent years, there have been some excellent reviews of several capability measurement instruments (Proud et al., 2019;Ubels et al., 2022) and their use in economic evaluations (Helter et al., 2019). These reviews show how capability can capture the outcomes of value in health and economic evaluations. ...
We investigated 34 deaf and hard-of-hearing children with hearing devices aged 8-12 years and 30 typical hearing peers. We used the capability approach to assess well-being in both groups through interviews. Capability is "the real freedom people have to do and to be what they have reason to value." Speech perception, phonology, and receptive vocabulary data of the deaf and hard-of-hearing children, that were used retrospectively, showed a large variability. The analysis of the relation between clinical quantitative outcome measures and qualitative capability interview outcomes suggests that at this age, differences in clinical performance do not appear to translate into considerable differences in capability, including capability did offer insight into the factors that appeared to ensure this equivalence of capability. We argue that capability outcomes should be used to determine the focus of (auditory) rehabilitation and support, in line with the United Nations Convention on the Rights of the Child.
... Secondary outcomes explored related to obesity, health and wellbeing. The following validated measures were used: King's Obesity Staging Criteria [28], ICEpop CAPability measure for Adults (ICECAP-A) [29], International Physical Activity Questionnaire (IPAQ) [30], Brief Mediterranean Diet Questionnaire [31], Alcohol Use Disorders Identification Test (AUDIT) [32], Dutch Eating Behaviour Questionnaire (DEBQ) [33], Hospital Anxiety and Depression Scale (HADS) [34], Weight in kilograms and ACT processes using: Distress Tolerance Scale (DTS) [35], Philadelphia Mindfulness Scale (PHLMS) [36], Drexel Defusion Scale (DDS) [37], Physical Activity Acceptance Questionnaire (PAAQ) [38], and Food Craving Acceptance and Awareness Questionnaire (FAAQ) [39]. ...
... Outcome measures were completed at baseline, 3, 6 and 12 months follow up, except for weight and the King's Obesity Staging Criteria [29] which were collected at baseline and 12 months only. Demographic data were collected at baseline. ...
Bariatric surgery is an effective treatment for obesity. However, around one in five people experience significant weight regain. Acceptance and Commitment Therapy (ACT) teaches acceptance of and defusion from thoughts and feelings which influence behaviour, and commitment to act in line with personal values. To test the feasibility and acceptability of ACT following bariatric surgery a randomised controlled trial of 10 sessions of group ACT or Usual Care Support Group control (SGC) was delivered 15–18 months post bariatric surgery (ISRCTN registry ID: ISRCTN52074801). Participants were compared at baseline, 3, 6 and 12 months using validated questionnaires to assess weight, wellbeing, and healthcare use. A nested, semi-structured interview study was conducted to understand acceptability of the trial and group processes. 80 participants were consented and randomised. Attendance was low for both groups. Only 9 (29%) ACT participants completed > = half of the sessions, this was the case for 13 (35%) SGC participants. Forty-six (57.5%) did not attend the first session. At 12 months, outcome data were available from 19 of the 38 receiving SGC, and from 13 of the 42 receiving ACT. Full datasets were collected for those who remained in the trial. Nine participants from each arm were interviewed. The main barriers to group attendance were travel difficulties and scheduling. Poor initial attendance led to reduced motivation to return. Participants reported a motivation to help others as a reason to join the trial; lack of attendance by peers removed this opportunity and led to further drop out. Participants who attended the ACT groups reported a range of benefits including behaviour change. We conclude that the trial processes were feasible, but that the ACT intervention was not acceptable as delivered. Our data suggest changes to recruitment and intervention delivery that would address this.
... In that context, a lot of attention is being paid to well-being outcomes, for which several questionnaires were developed in recent years [27]. Well known instruments include the Adult Social Care Outcomes Toolkit (ASCOT) [28] and the ICEpop CAPability measure for Older people (ICECAP-O) [29,30]. The ASCOT focuses on social care related quality of life and, similar to our outcome measures, also includes 'social participation' as one of their 8 domains. ...
Purpose
For an integrated care programme to be successful, preferences of the stakeholders involved should be aligned. The aim of this study is to investigate to which extent outcomes beyond health are valued and to study the heterogeneity of preferences of those involved in integrated care.
Methods
A discrete choice experiment (DCE) was conducted to elicit preferences for eight Triple Aim outcomes, i.e., physical functioning, psychological well-being, social relationships & participation, enjoyment of life, resilience, person-centeredness, continuity of care and total health and social care costs. Stakeholders were recruited among Dutch persons with multi-morbidity, informal caregivers, professionals, payers, and policymakers. A Bayesian mixed-logit model was used to analyse the data. Subsequently, a latent class analysis was performed to identify stakeholders with similar preferences.
Results
739 stakeholders completed the DCE. Enjoyment of life was perceived as the most important outcome (relative importance: 0.221) across stakeholders, while total health and social care costs were perceived as least important (0.063). The latent class analysis identified four classes. The first class (19.9%) put most weight on experience with care outcomes. The second class (39%) favoured enjoyment of life. The third class (18%) focused relatively more on physical health. The fourth class (24%) had the least consistent preferences.
Conclusion
This study has highlighted the heterogeneity in views of stakeholders in integrated care on what is important in health(care) for persons with multi-morbidity. To accurately value integrated care a variety of outcomes beyond health–e.g., enjoyment of life and experience with care–should be taken into account.
