Philip Kinghorn

University of Birmingham · Department of Health Economics

Recent years have seen increased engagement amongst health economists with the capability approach developed by Amartya Sen and others. This paper focuses on the capability approach in relation to the evaluative space used for analysis within health economics. It considers the opportunities that the capability approach offers in extending this spac...

Healthcare policy leaders internationally recognise that people's experiences of healthcare delivery are important, and invest significant resources to monitor and improve them. However, the value of particular aspects of experiences of healthcare delivery – relative to each other and to other healthcare outcomes – is unclear. This paper considers...

This paper reports a qualitative study which sought to operationalise Sen’s capability approach in the context of chronic pain. The resulting capability-instrument will allow treatments and services to be evaluated according to whether they enable users to achieve those things which they value in life. This is particularly important in chronic cond...

Background The UK Medical Research Council approach to evaluating complex interventions moves through development, feasibility, piloting, evaluation and implementation in an iterative manner. This approach might be useful as a conceptual process underlying complex valuation tasks. Objective The objective of the study was to explore the applicabilit...

Falls among older adults pose a significant public health challenge, as they lead to severe outcomes such as fractures and loss of independence. Research has shown that training cognitive function and balance simultaneously, termed Dual-Task (DT) training, improves mobility and reduces fall risks in older adults. This study aims to evaluate the fea...

The capability approach provides a broad evaluative space for making funding decisions for health and care interventions, with capability wellbeing as the outcome of value. A range of capability measures have been developed for the economic evaluation of health and care interventions for adults. However, such measures have not been previously devel...

Purpose This study explores how important well-becoming factors appear to be to children during childhood. We define well-becoming as the indicators which predict children and young people’s future wellbeing and opportunities. The priority for this work was to explore whether well-becoming might be an important factor to include in outcome measures...

Background. Between 2015 and 2020, 1,578 care homes in the UK closed, displacing nearly 50,000 older and disabled people with very significant care and support needs. It is widely thought that relocation can have a significant impact on the health and well-being of older people. Yet, evidence is limited due to sensitivity and logistical difficultie...

Healthcare innovations often represent important improvements in population welfare, but at what cost, and to whom? Health technology assessment (HTA) is a multidisciplinary process to inform resource allocation. HTA is conventionally anchored on health maximization as the only relevant output of health services. If we accept the proposition that h...

Introduction Economic evaluation currently focuses almost exclusively on the maximization of health, using the Quality-Adjusted Life-Year (QALY) framework with instruments such as the EQ-5D, with a limited number of health-focused dimensions providing the assessment of health benefit. This evaluative framework is likely to be insufficient for setti...

Background: The ICECAP-Supportive Care Measure (SCM) is a self-complete measure developed to inform economic decision making at the end-of-life. Previous research has demonstrated its feasibility in hospice and nursing home settings. This is the first study of its use with patients on the organ failure trajectory. Aim: To determine the feasibili...

Background: Health services face difficult choices regarding how to allocate scarce health and social care resources. Economic evaluation can aid this process of decision making by allowing competing healthcare interventions or services to be compared in terms of their costs and consequences. However, existing use of economic evaluation of health s...

Whilst the need to better understand the effectiveness of social care interventions is accepted, there is disagreement about measurement. Quantifiable measures for wellbeing/quality of life (QoL) have been adopted in healthcare but not in social care. Here, the most widely adopted measurement tool is the English Adult Social Care Outcomes Toolkit d...

Aim: Explore the use of deliberative valuation to elicit relative weights for a set of capabilities identified as being important and relevant to those close to patients receiving supportive care at the end of life. Methods: Focus groups, involving the general UK population (n = 38) and policy-makers (n = 29) with experience of, and influence on, p...

Background: Eliciting health-state utility values (HSUVs) for some diseases is complicated by the mix of associated temporary (THSs) and chronic health states (CHSs). This study uses one such disease, chlamydia infection, to explore the challenges. The objectives were to: 1) Define a set of health-state descriptions related to chlamydia and 2) Deri...

Methods for measuring outcomes suitable for economic evaluations of health and care interventions have primarily focused on adults. The validity of such methods for children and young people is questionable in areas including the outcome domains measured and how they are measured and valued, with most existing measures narrowly focusing on health....

Aim To elicit a deliberative monetary value for a year of sufficient capability well-being (YSC) and a year of full capability (YFC), to inform decision-making in the contexts of social care and public health. Methods 69 members of the public, recruited from purposively selected electoral wards across the West Midlands Region of England, attended...

The capability approach is potentially valuable for economic evaluation at the end of life because of its conceptualization of wellbeing as freedom and the potential for capturing outcomes for those at end of life and those close to persons at the end of life. For decision making, however, this information needs to be integrated into current evalua...

Background The evaluation of care strategies at the end of life is particularly important due to the globally increasing proportion of very old people in need of care. The ICECAP-Supportive Care Measure is a self-complete questionnaire developed in the UK to evaluate palliative and supportive care by measuring patient’s wellbeing in terms of ‘capab...

Background The ICECAP capability measures are increasingly being used to capture the impact of health and social care interventions on well-being. In cases where the recipient of an intervention is highly vulnerable, proxy completion may be necessary. This study adds to the limited existing evidence on proxy completion of ICECAP-A specifically and...

Objectives Development of the ICEpop CAPability measure for Adults (ICECAP-A) was reported in 2012; use of certain capability measures was suggested in the context of social or long-term care soon afterward by decision-making organizations in the United Kingdom and The Netherlands. Despite enthusiasm for the ICECAP-A, this study represents the firs...

Background: Health maximisation is unlikely to be a relevant objective for social care, where service users and the workforce have distinct priorities and needs. NICE permit use of a small number of capability-based measures for the evaluation of social care, including ICECAP-A, a measure with five attributes, each with four levels. Aim: To esta...

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...

Background:: The use of quality-adjusted life years rests on the assertion that the objective of the health care system is to improve health. Aim:: To elicit the views of expert stakeholders on the purpose and evaluation of supportive end of life care, and explore how different purposes of end of life care imply the need for different evaluative...

Background Guidelines for economic evaluations often request that costs and outcomes beyond the patient are captured; this can include carers and also other affected parties. End-of-life care is one context where impacts of care spill over onto those other than patients, but there is little evidence about who should be included within economic eval...

Background Values used in economic evaluation are typically obtained from the general public, which is problematic when measures are to be used with people experiencing a life-course stage such as the end of life. Objective To assess the feasibility of obtaining values for the ICECAP-Supportive Care Measure (SCM) from patients receiving advanced s...

This organized session called 'Outcomes beyond EuroQoL' is chaired by dr. Philip Kinghorn, and composed of three presentations: 1) Assessing quality of life internationally in healthy and seven health condition groups using the ICECAP-A capability wellbeing measure - dr. Paul Mitchell 2) A comparison of the responsiveness of EQ-5D-5L and the QOLIE...

Background Eleven million people suffer a fire-related injury worldwide every year, and 71% have significant scarring. Pressure garment therapy (PGT) is a standard part of burn scar management, but there is little evidence of its clinical effectiveness or cost-effectiveness. Objective To identify the barriers to, and the facilitators of, conductin...

Plain English summary In the UK, more patients go to primary care than other parts of the health service. Therefore it is important for research into primary care to include the insights and views of people who receive these services. To explore the extent, quality and impact of patient and public involvement (PPI) in primary care research, we exam...

Background and objectives: Adaptive preferences occur when people subconsciously alter their views to account for the possibilities available to them. Adaptive preferences may be problematic where these views are used in resource allocation decisions because they may lead to underestimation of the true benefits of providing services. This research...

Background Sen’s capability approach is underspecified; one decision left to those operationalising the approach is how to identify sets of relevant and important capabilities. Sen has suggested that lists be developed for specific policy or research objectives through a process of public reasoning and discussion. Robeyns offers further guidance in...

Background: Pressure garment therapy (PGT) is an established treatment for the prevention and treatment of hypertrophic scarring; however, there is limited evidence for its effectiveness. Burn survivors often experience multiple issues many of which are not adequately captured in current PGT trial measures. To assess the effectiveness of PGT it is...

Introduction: Parents have a crucial role to play in burn scar management for their children at a time that is extremely stressful for them and their child. Scar management treatments such as pressure garment therapy (PGT) require high levels of adherence. There has been a lack of research into the factors that may influence adherence in paediatri...

End of life care may have elements of value that go beyond health. A generic measure of the benefits of end of life care could be helpful to decision makers. Such a measure, based on the capability approach, has recently been developed: the ICECAP Supportive Care Measure. This paper reports the first valuation exercise for that measure, with data f...

Background The primary purpose of this study is to assess the existing evidence on the cost-effectiveness of surgical interventions for the management of knee and hip osteoarthritis by systematically reviewing published economic evaluation studies. MethodsA systematic review was conducted for the period 2004 to 2016. Electronic databases were searc...

Background: A broad literature on health state utility values exists, but compared with chronic health states (HSs), issues surrounding the valuation of temporary health states (THSs) have been poorly explored. Objectives: To assess the methods used by previous studies to value HSs that are considered temporary so as to determine the strengths a...

Introduction There are several well-known barriers to conducting research in hospices. Hospices may lack experience of research and have less developed governance procedures. The vulnerability of patients and the sensitivity of the topic may also form real, or perceived, barriers. Recruitment of participants to end-of-life projects therefore tends...

Introduction Patients near the end of life are not always able to consent to research participation but it is important they have the opportunity to be represented. Proxies may offer a valuable perspective on the quality of end of life care. Although there is evidence that proxy responses differ, exploring why and where differences occur may help i...

Background Low back pain (LBP) is a major health problem, having a substantial effect on peoples’ quality of life and placing a significant economic burden on health care systems and, more broadly, societies. Many interventions to alleviate LBP are available but their cost-effectiveness is unclear. Objectives To identify, document and appraise stu...

Research is vital to the future development of hospice care. However, research in hospice settings is very challenging. This paper describes a case study of a successful multidisciplinary research team approach (MDRT) to the recruitment of participants (hospice patients, family members and health professionals) for a study in a hospice setting on t...

Background: The ICECAP-Supportive Care Measure is a self-complete questionnaire developed to aid economic evaluation of supportive care interventions. Aim: To determine the feasibility of completing ICECAP-Supportive Care Measure alongside EQ-5D-5L and ICECAP-A (generic measures used in economic evaluation) among patients receiving hospice care, cl...

Background: End-of-life care affects both the patient and those close to them. Typically, those close to the patient are not considered within economic evaluation, which may lead to the omission of important benefits resulting from end-of-life care. Aim: To develop an outcome measure suitable for use in economic evaluation that captures the bene...

The capability approach is concerned with evaluating interventions in terms of their impact on a person’s well-being assessed as their ability to do and be things in life – their ‘capability’. It is increasingly being adopted to evaluate health and social care interventions in cases where the QALY would provide a partial assessment of outcomes. It...

In comparing the first applications of the capability approach (CA) to health and health care by Ruger with three subsequent interpretations of the CA, this paper identifies two distinct motivations: (i) the adoption of capability as an alternative to utilitarian health maximization, in the context of resource allocation and (ii) facilitating agree...

The ICECAP Supportive Care Measure (ICECAP-SCM) is a self-complete questionnaire developed to rate quality towards the end of life, particularly for economic evaluation. It measures a person's capability to experience a good life and death. The study aimed to determine the feasibility of completing ICECAP-SCM alongside EQ-5D-5L and ICECAP-A (measur...

End of life care (EoLC) concerns the needs of both patients and those close to them. Current methods of economic evaluation typically focus on the patient and, only infrequently, the health of the carer. There are strong arguments that impacts on those close to the patient should also be included within economic evaluation. It is therefore importan...

Patient and Public Involvement (PPI) in research is good practice and is often a requirement of funding bodies, such as the National Institute for Health Research (NIHR). However, little is known about the costs (financial and non-financial) and consequences (impact) of PPI for organisations, researchers, and patients involved. This presentation wi...

Patient and Public Involvement (PPI) in research is seen as good practice and is a requirement of NIHR funding. However, there is variability in PPI practice and a true understanding of the costs (financial and non-financial) and consequences (impact) of PPI is lacking. This study aims to investigate the costs and consequences of PPI within primary...

Objectives To report findings from a systematic review, this article sought to address two related questions. First, how has the practice of UK pediatric cost-utility analyses evolved over time, in particular how are health-related outcomes assessed and valued? Second, how do the methods compare to the limited guidance available, in particular, the...

Measuring the quality of end-of-life with generic health instruments has received criticism amongst palliative care researchers. The ICECAP Supportive Care Measure (ICECAP-SCM) is a self-complete questionnaire developed to evaluate palliative and supportive care. Using attributes involving autonomy, love, physical and emotional suffering, dignity,...

The most common approach to health economic evaluation is based on the principle of maximising total health, with outcomes of value being gains in health and length of life, the 'Q' and 'LY' elements of quality adjusted life years (QALYs). Health is commonly defined in terms of: pain/discomfort; anxiety/depression; mobility; self care; and usual ac...

Background: In 2011 the Palliative Care Funding Review highlighted concerns about the funding, provision, and quality of care at the end of life. Two years on, an independent review of the Liverpool Care Pathway--prompted by a storm of negative media coverage--has raised concerns around a lack of funding, availability of support for the dying and...

Patients' experiences are often treated as health care quality indicators. Our aim was to identify the range of experiences of health care delivery that matter to patients and to produce a conceptual map to facilitate consideration of why they matter. Broad-based review and critical interpretive synthesis of research literature on patients' perspec...

Between seven and ten percent of the UK population suffers from chronic pain. Previous studies have reported that sufferers experience a self-enforced withdrawal from usual activities related to work, pleasure and family; this withdrawal is a source of major concern, social isolation and hardship. The aim of this study is to discover how chronic pa...