Using the ICECAP indices to measure capability wellbeing in the UK Joanna Coast Rome, May 2012

Using the ICECAP indices to measure

capability wellbeing in the UK

Joanna Coast

Rome, May 2012

ICECAP indices: Rome, May 2012

www.birmingham.ac.uk/icecap

Outline

Context & challenges in using capability for economic evaluation

The ICECAP indices

Use of the ICECAP indices– To assess deprivation– To assess intervention/policy change

Further research



Context & challenges in using capability for economic evaluation



The context

Decision making across health & other sectors in the UK

Method required that is individual-based (for use in clinical trials/decision analysis)

Current approach: QALY maximisation

– Focus only on health problematic particularly in some areas Public health Social care End of life care



The challenge

Deliberately underspecified nature of the capability approach (Sen, 1993)

– ‘Quite different specific theories of value may be consistent with the capability approach, and share the common feature of selecting value-objects from functionings and capabilities. Further, the capability approach can be used with different methods of determining relative weights and different mechanisms for actual evaluation.’ (Sen, 1993) (p. 48).

‘Too vague to be of use?’ (Sugden, 1993)



The measurement challenge

Capabilities or functionings?

Participatory methods?

Truly ‘objective’ or perceived capabilities?

Inclusion of ‘capabilities’ that influence other ‘capabilities’

– E.g. health



The valuation challenge Sen rejects use of (individual’s) choices or desires to

value capabilities – concern with adaptation

Other options

– Deliberation & debate– Value judgements elicited from population as ‘evidence’ for

values (‘Cookson’s compromise’)

Anchoring of values

Anchoring considered important in health economics literature so as to be able to think about both length & quality of life



The ICECAP indices



The measurement challenge: ICECAP Capabilities or functionings?

Participatory methods?

– Used extensively – in-depth qualitative methods to determine capabilities

Truly ‘objective’ or perceived capabilities?

Inclusion of ‘capabilities’ that influence other ‘capabilities’

– Aimed to identify those ‘end-point’ capabilities that are fundamentally important to people



The valuation challenge: ICECAP Sen rejects use of (individual’s) choices or desires to

value capabilities – concern with adaptation

Other options

– Deliberation & debate– Value judgements elicited from population as ‘evidence’ for

values (‘Cookson’s compromise’)

Anchoring of values

Anchor on ‘full capability’ and ‘no capability’: those who have died have no capability on any attribute



ICECAP development – all versions

Phase 1: in-depth interviews to generate conceptual attributes for measures, analysed using constant comparative methods

Phase 2: semi-structured interviews to check attributes and develop meaningful wording for measures

Phase 3: valuation using best-worst scaling amongst general population

Phase 4: assessment of feasibility, validity, reliability, sensitivity to change



ICECAP



ICECAP



ICECAP

ICECAP-O

– Older people

ICECAP-A

– Adult population

ICECAP-SCM

– End of life



5 questions, each with 4 response categories.

1024 possible ‘capability wellbeing’ states.

ICECAP-O



ICECAP-O index values

-0.1 0 0.1 0.2 0.3

Attachment

Security

Role

Enjoyment

Control

Values rescaled such that 11111 equals zero and 44444 equals one

4

3

2

1

No capability on all attributes: value 0

A little capability on all attributes: value 0.556

A lot of capability on all attributes: value 0.868

Full capability on all attributes: value 1



Similar format.

Aims to tap into some domains of importance to general adult population not captured in ICECAP-O.

ICECAP-A



Preliminary values

Preliminary UK index values for ICECAP-A

-0.05

0

0.05

0.1

0.15

0.2

0.25

L1 L2 L3 L4 L1 L2 L3 L4 L1 L2 L3 L4 L1 L2 L3 L4 L1 L2 L3 L1

Stability Attachment Autonomy Achievement EnjoymentAttribute

ind

ex v

alu

e No capability on all attributes: value 0 A little capability on all attributes: value 0.43 A lot of capability on all attributes: value 0.86 Full capability on all attributes: value 1



ICECAP-SCM 1) Having a say (Your ability to influence where you would like to live or be

cared for, the kind of treatment you receive, the people who care for you)

2) Being with people who care about you (Being with family, friends or caring professionals

3) Physical suffering (Experiencing pain or physical discomfort which interferes with your daily activities)

4) Emotional suffering (Experiencing worry or distress, feeling like a burden)

5) Dignity (Being yourself, being clean, having privacy, being treated with respect, being spoken to with respect, having your religious or spiritual beliefs respected)

6) Being supported (Having help and support)

7) Being prepared (Having financial affairs in order, having your funeral planned, saying goodbye to family and friends, resolving things that are important to you, having treatment preferences in writing or making a living will)



Use of the ICECAP indices



Included in more than 40 studies



Assessing deprivation with ICECAP

Division of Primary Health CareBristol Research Network presentation 2008



Mean ICECAP-O scores: older BristoliansMale 0.837 General health good 0.882

Female 0.826 GH fairly good 0.835

Age 65-74 0.838 GH not good 0.725

Age 75+ 0.819

White 0.832 Live alone 0.809

BME 0.808 Live with others 0.842

Have a faith 0.836 Dental care: NHS 0.828

No faith 0.803 Dental care: private 0.869

Not carer 0.836 Dental care: none 0.798

Carer 0.800

Receive benefits 0.777 Have qualification 0.855

Do not receive benefits 0.844 Not have qualification 0.817

Benefits N/A 0.851



ICECAP-O multi-variable regression

Explaining capability wellbeing as measured by ICECAP

Significant relationships (10%) in final model

– ‘Do not have a faith’ (<0.001)

– Live alone (0.01)

– Meeting friends/family daily (0.01)

– Perceived influence on local decision making (0.04)

– Feeling safe (indoors after dark) (0.001)

– Dental care (0.06)

– General health (<0.001)

– Housebound for any reason (<0.001)

– Disabled (0.01)

– Sleep quality (0.001)



Associations ICECAP-A and health



Assessing intervention/policy change with ICECAP



Change following treatment (n=56)

Coefficient se Lower Upper

ICECAP-O score 0.070 0.016 0.038 0.102

Change in individual index values (on 0-1 scale)

Attachment -0.010 0.006 -0.022 0.002

Security 0.021 0.007 0.007 0.035

Role 0.017 0.005 0.008 0.027

Enjoyment 0.020 0.005 0.011 0.029

Control 0.021 0.005 0.012 0.031





ICECAP-O score 0.070 0.016 0.038 0.102


Attachment -0.010 0.006 -0.022 0.002

Security 0.021 0.007 0.007 0.035

Role 0.017 0.005 0.008 0.027

Enjoyment 0.020 0.005 0.011 0.029

Control 0.021 0.005 0.012 0.031





ICECAP-O score 0.070 0.016 0.038 0.102


Attachment -0.010 0.006 -0.022 0.002

Security 0.021 0.007 0.007 0.035

Role 0.017 0.005 0.008 0.027

Enjoyment 0.020 0.005 0.011 0.029

Control 0.021 0.005 0.012 0.031



Further research



Finalise & publish ICECAP-A values

Finalise descriptive system for ICECAP-SCM & generate values

Assessments of validity & reliability for all measures

Work on use of measures in studies of efficiency & equity

Wealth of qualitative data – better understanding of issues such as agency & adaptation



ICECAP measures

Freely available (subject to registration):

– Downloadable forms at: www.birmingham.ac.uk/icecap – Index values– Some translations available.

Emerging evidence of validity:

– In general population samples– In specific clinical areas.

Endorsement from SCIE; interest from other reimbursement agencies UK and Netherlands



Acknowledgements

MRC funding to fully develop ICECAP-O, ICECAP-A and early development for ICECAP-SCM

Large programme of European Research Council funding forcontinued work on ICECAP-SCM

All collaborators, in particular: Hareth Al-Janabi, Terry Flynn, Phil Kinghorn, Rosanna Orlando, Eileen Sutton,



Key references Grewal I, Lewis J, Flynn T, Brown J, Bond, J, Coast J. Developing attributes for a generic

quality of life measure for older people: preferences or capabilities? Social Science and Medicine. 2006;62(8):1891-1901.

Coast J, Flynn TN, Natarajan L, Sproston K, Lewis J, Louviere JJ, Peters TJ. Valuing the ICECAP capability index for older people. Social Science & Medicine. 2008;67:874-882

Coast J, Peters TJ, Natarajan L, Sproston K, Flynn TN. An assessment of the construct validity of the descriptive system for the ICECAP capability measure for older people. Quality of Life Research. 2008;17;967-976

Flynn TN, Chan P, Coast J, Peters TJ. Assessing quality of life among British older people using the ICECAP-O capability measure. Applied Health Economics and Health Policy. 2011;9(5):317-329.

Makai P, Brouwer WB, Koopmanschap MA, Nieboer AP. Capabilities and quality of life in Dutch psycho-geriatric nursing homes: an exploratory study using a proxy version of the ICECAP-O. Quality of Life Research 2012;21(5):801-12.

Al-Janabi H, Flynn T, Coast J. Development of a self-report measure of capability wellbeing for adults: the ICECAP-A. Quality of Life Research. 2012; 21:167–176.

Documents

Using the ICECAP indices to measure capability wellbeing in the UK Joanna Coast Rome, May 2012