Skip to main content
Log in

An Investigation of the Overlap Between the ICECAP-A and Five Preference-Based Health-Related Quality of Life Instruments

  • Original Research Article
  • Published:
PharmacoEconomics Aims and scope Submit manuscript

Abstract

Background

The ICEpop CAPability measure for Adults (ICECAP-A) is a measure of capability wellbeing developed for use in economic evaluations. It was designed to overcome perceived limitations associated with existing preference-based instruments, where the explicit focus on health-related aspects of quality of life may result in the failure to capture fully the broader benefits of interventions and treatments that go beyond health. The aim of this study was to investigate the extent to which preference-based health-related quality of life (HRQoL) instruments are able to capture aspects of capability wellbeing, as measured by the ICECAP-A.

Methods

Using data from the Multi Instrument Comparison project, pairwise exploratory factor analyses were conducted to compare the ICECAP-A with five preference-based HRQoL instruments [15D, Assessment of Quality of Life 8-dimension (AQoL-8D), EQ-5D-5L, Health Utilities Index Mark 3 (HUI-3), and SF-6D].

Results

Data from 6756 individuals were used in the analyses. The ICECAP-A provides information above that garnered from most commonly used preference-based HRQoL instruments. The exception was the AQoL-8D; more common factors were identified between the ICECAP-A and AQoL-8D compared with the other pairwise analyses.

Conclusion

Further investigations are needed to explore the extent and potential implications of ‘double counting’ when applying the ICECAP-A alongside health-related preference-based instruments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Drummond M, Sculpher M, Claxton K, et al. Methods for the economic evaluation of health care programmes. 4th ed. Oxford: Oxford University Press; 2015.

    Google Scholar 

  2. Weinstein MC, Torrance G, McGuire A. QALYs: the basics. Value Health. 2009;12(Suppl. 1):S5–9.

    Article  PubMed  Google Scholar 

  3. CADTH. Guidelines for the economic evaluation of health technologies: Canada, 3rd edn. Ottawa: CADTH; 2006.

  4. NICE. Guide to the methods of technology appraisal. London: NICE; 2013.

  5. Nederland Zorginstituut. Richtlijn voor het uitvoeren van economische evaluaties in de gezondheidszorg. Diemen: Zorginstituut Nederland; 2016.

    Google Scholar 

  6. Mooney G. QALYs: are they enough? A health economist’s perspective. J Med Ethics. 1989;15(3):148–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Mooney G. Beyond health outcomes: the benefits of health care. Health Care Anal. 1998;6(2):99–105.

    Article  CAS  PubMed  Google Scholar 

  8. Ryan M, Shackley P. Assessing the benefits of health care: how far should we go? Qual Health Care. 1995;4(3):207–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Lorgelly PK, Lawson KD, Fenwick EA, Briggs AH. Outcome measurement in economic evaluations of public health interventions: a role for the capability approach? Int J Environ Res Public Health. 2010;7(5):2274–89.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Netten A, Burge P, Malley J, et al. Outcomes of social care for adults: developing a preference-weighted measure. Health Technol Assess. 2012;16(16):1–166.

    Article  CAS  PubMed  Google Scholar 

  11. Connell J, O’Cathain A, Brazier J. Measuring quality of life in mental health: are we asking the right questions? Soc Sci Med. 2014;120:12–20.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Coast J. Strategies for the economic evaluation of end-of-life care: making a case for the capability approach. Expert Rev Pharmacoecon Outcomes Res. 2014;14(4):473–82.

    Article  PubMed  Google Scholar 

  13. Makai P, Brouwer WBF, Koopmanschap MA, et al. Quality of life instruments for economic evaluations in health and social care for older people: a systematic review. Soc Sci Med. 2014;102:83–93.

    Article  PubMed  Google Scholar 

  14. Dodge R, Daly AP, Huyton J, Sanders LD. The challenge of defining wellbeing. Int J Wellbeing. 2012;2(3):222–35.

    Article  Google Scholar 

  15. Ryff D, Singer B. Know thyself and become what you are: a eudaimonic approach to psychological well-being. J Happiness Stud. 2008;9(1):13–39.

    Article  Google Scholar 

  16. Diener E, Suh EM, Lucas RE, Smith HL. Subjective well-being: three decades of progress. Psychol Bull. 1999;125(2):276–302.

    Article  Google Scholar 

  17. Sen A. Capability and well-being, in the quality of life. Nussbaum M, Sen A, editors. Oxford: Oxford University Press; 1993.

  18. Bleichrodt H, Quiggin J. Capabilities as menus: a non-welfarist basis for QALY evaluation. J Health Econ. 2013;32(1):128–37.

    Article  PubMed  Google Scholar 

  19. Al-Janabi H, Flynn T, Coast J. Development of a self-report measure of capability wellbeing for adults: the ICECAP-A. Qual Life Res. 2012;21(1):167–76.

    Article  PubMed  Google Scholar 

  20. Lorgelly PK. Choice of outcome measure in an economic evaluation: a potential role for the capability approach. Pharmacoeconomics. 2015;33(8):849–55.

    Article  PubMed  Google Scholar 

  21. Coast J, Peters TJ, Natarajan L, et al. An assessment of the construct validity of the descriptive system for the ICECAP capability measure for older people. Qual Life Res. 2008;17(7):967–76.

    Article  PubMed  Google Scholar 

  22. Sutton EJ, Coast J. Development of a supportive care measure for economic evaluation of end-of-life care using qualitative methods. Palliat Med. 2014;28(2):151–7.

    Article  PubMed  Google Scholar 

  23. NICE. Developing NICE guidelines: the manual. London: NICE; 2014.

  24. Flynn TN, Huynh E, Peters TJ, et al. Scoring the ICECAP-A capability instrument: estimation of a UK general population tariff. Health Econ. 2015;24(3):258–69.

    Article  PubMed  Google Scholar 

  25. Brooks R. EuroQol: the current state of play. Health Policy. 1996;37(1):53–72.

    Article  CAS  PubMed  Google Scholar 

  26. Herdman M, Gudex C, Lloyd A, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Davis JC, Liu-Ambrose T, Richardson CG, Bryan S. A comparison of the ICECAP-O with EQ-5D in a falls prevention clinical setting: are they complements or substitutes? Qual Life Res. 2013;22(5):969–77.

    Article  PubMed  Google Scholar 

  28. Keeley T, Coast J, Nicholls E, et al. An analysis of the complementarity of ICECAP-A and EQ-5D-3L in an adult population of patients with knee pain. Health Qual Life Outcomes. 2016;14(1):36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Richardson J, Iezzi A, Khan MA. Why do multi-attribute utility instruments produce different utilities: the relative importance of the descriptive systems, scale and ‘micro-utility’ effects. Qual Life Res. 2015;24(8):2045–53.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Richardson J, McKie J, Bariola E. Multiattribute utility instruments and their use. In: Culyer AJ, editor. Encyclopedia of health economics. San Diego: Elsevier; 2014. p. 341–57.

    Chapter  Google Scholar 

  31. Whitehurst DG, Norman R, Brazier JE, Viney R. Comparison of contemporaneous EQ-5D and SF-6D responses using scoring algorithms derived from similar valuation exercises. Value Health. 2014;17(5):570–7.

    Article  PubMed  Google Scholar 

  32. Karimi M, Brazier J. Health, health-related quality of life, and quality of life: what is the difference? Pharmacoeconomics. 2016;34(7):645–9.

    Article  PubMed  Google Scholar 

  33. Richardson J, Iezzi A, Maxwell A. Cross-national comparison of twelve quality of life instruments. MIC paper 1: background, questions, instruments. Research paper 76. Melbourne (VIC): Centre for Health Economics, Monash University; 2012. Available from: http://www.aqol.com.au/papers/researchpaper76.pdf. Accessed 28 Jan 2017.

  34. Sintonen H. The 15D instrument of health-related quality of life: properties and applications. Ann Med. 2001;33(5):328–36.

    Article  CAS  PubMed  Google Scholar 

  35. Hawthorne G, Richardson J, Osborne R. The Assessment of Quality of Life (AQoL) instrument: a psychometric measure of health-related quality of life. Qual Life Res. 1999;8(3):209–24.

    Article  CAS  PubMed  Google Scholar 

  36. Richardson J, Iezzi A, Khan MA, et al. Data used in the development of the AQoL-8D (PsyQoL) quality of life instrument. Melbourne: Centre for Health Economics, Monash University; 2009.

    Google Scholar 

  37. Feeny D, Furlong W, Torrance GW, et al. Multiattribute and single-attribute utility functions for the health utilities index mark 3 system. Med Care. 2002;40(2):113–28.

    Article  PubMed  Google Scholar 

  38. Seiber WJ, Groessl EJ, David KM, et al. Quality of Well Being Self Administered (QWB-SA) Scale: user’s manual. 2008. Available from: https://hoap.ucsd.edu/qwb-info/QWB-Manual.pdf. Accessed 28 Jan 2017.

  39. Ware JE Jr, Kosinski M, Bjorner JB, et al. SF-36v2® Health Survey: administration guide for clinical trial investigators. Lincoln: Quality Metric Incorporated; 2008.

    Google Scholar 

  40. Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ. 2002;21(2):271–92.

    Article  PubMed  Google Scholar 

  41. Perreault WD. Controlling order-effect bias. Public Opin Q. 1976;39(4):544–51.

    Article  Google Scholar 

  42. Muthén LK, Muthén BO. Mplus user’s guide, 7th ed (1998–2015). Los Angeles: Muthén & Muthén; 2015.

  43. Fabrigar LR, Wegener DT. Understanding statistics: exploratory factor analysis. New York: Oxford University Press; 2012.

    Google Scholar 

  44. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: Erlbaum; 1988.

    Google Scholar 

  45. Fabrigar LR, Wegener DT, MacCallum RC, Strahan EJ. Evaluating the use of exploratory factor analysis in psychological research. Psychol Methods. 1999;4(3):272–99.

    Article  Google Scholar 

  46. Geiser C. Data analysis with Mplus. New York: Guilford Press; 2013.

    Google Scholar 

  47. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Modeling. 1999;6(1):1–55.

    Article  Google Scholar 

  48. Costello AB, Osborne JW. Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. Pract Assess Res Eval. 2005;10(7):1–9.

    Google Scholar 

  49. Whitehurst DG, Bryan S. Another study showing that two preference-based measures of health-related quality of life (EQ-5D and SF-6D) are not interchangeable. But why should we expect them to be? Value Health. 2011;14(4):531–8.

    Article  PubMed  Google Scholar 

  50. Richardson J, Chen G, Khan MA, Iezzi A. Can multi-attribute utility instruments adequately account for subjective well-being? Med Decis Mak. 2015;35(3):292–304.

    Article  Google Scholar 

  51. Makai P, Looman W, Adang E, et al. Cost-effectiveness of integrated care in frail elderly using the ICECAP-O and EQ-5D: does choice of instrument matter? Eur J Health Econ. 2015;16(4):437–50.

    Article  PubMed  Google Scholar 

  52. Goranitis I, Coast J, Day E, et al. Maximizing health or sufficient capability in economic evaluation? A methodological experiment of treatment for drug addiction. Med Decis Mak. 2016. doi:10.1177/0272989X16678844.

    Google Scholar 

  53. Mitchell PM, Roberts TE, Barton PM, Coast J. Assessing sufficient capability: a new approach to economic evaluation. Soc Sci Med. 2015;139:71–9.

    Article  PubMed  Google Scholar 

  54. Mitchell PM, Al-Janabi H, Richardson J, et al. The relative impacts of disease on health status and capability wellbeing: a multi-country study. PLoS One. 2015;10(12):e0143590.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Cookson R. QALYs, and the capability approach. Health Econ. 2005;14(8):817–29.

    Article  PubMed  Google Scholar 

  56. Cookson R. QALYs and capabilities: a response to Anand. Health Econ. 2005;14(12):1287–9.

    Article  Google Scholar 

  57. Karimi M, Brazier J, Basarir H. The capability approach: a critical review of its application in health economics. Value Health. 2016;19(6):795–9.

    Article  PubMed  Google Scholar 

  58. Engel L, Bansback N, Bryan S, et al. Exclusion criteria in national health state valuation studies: a systematic review. Med Decis Mak. 2016;36(7):798–810.

    Article  Google Scholar 

  59. Xie F, Gaebel K, Perampaladas K, et al. Comparing EQ-5D valuation studies: a systematic review and methodological reporting checklist. Med Decis Mak. 2013;34(1):8–20.

    Article  CAS  Google Scholar 

  60. Mitchell PM, Venkatapuram S, Richardson J, Iezzi A, Coast J. Are quality-adjusted life years a good proxy measure of individual capabilities? Pharmacoeconomics. 2017. doi:10.1007/s40273-017-0495-3.

    PubMed  PubMed Central  Google Scholar 

  61. Prieto L, Alonso J, Lamarca R. Classical test theory versus rasch analysis for quality of life questionnaire reduction. Health Qual Life Outcomes. 2003;1:27.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank Dr. Helen McTaggart-Cowan for her discussion of our paper at the 6th Vancouver Health Economics Methodology (VanHEM) meeting, Dr. Mark Oppe for his discussion at the 33rd EuroQol Group Plenary Meeting, and two anonymous reviewers for their constructive comments. This study is a secondary analysis using data from the Multi Instrument Comparison (MIC) project. None of the authors are investigators on the MIC project. For details of the MIC project, including the process for data requests, see http://www.aqol.com.au/index.php/aqol-current (accessed 28 January, 2017).

Authors’ contributions

LE, DM, SB, and DGTW were involved in the conception of the research question and design of the study. LE performed data analyses and drafted the original manuscript. All authors were involved in the interpretation of results and the review of the draft manuscript, and read and approved the final version prior to submission.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David G. T. Whitehurst.

Ethics declarations

Funding

This work has been conducted without financial support.

Conflict of interest

SB and DGTW are members of the EuroQol Group. The authors report no further conflicts of interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 46 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Engel, L., Mortimer, D., Bryan, S. et al. An Investigation of the Overlap Between the ICECAP-A and Five Preference-Based Health-Related Quality of Life Instruments. PharmacoEconomics 35, 741–753 (2017). https://doi.org/10.1007/s40273-017-0491-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40273-017-0491-7

Keywords

Navigation