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									                Using the ICECAP
                indices to measure
               capability wellbeing
                    in the UK
Joanna Coast
Rome, May 2012
Outline
o    Context & challenges in using capability for
     economic evaluation
o    The ICECAP indices
o    Use of the ICECAP indices
       – To assess deprivation
       – To assess intervention/policy change
o    Further research

ICECAP indices: Rome, May 2012


                                                www.birmingham.ac.uk/icecap
    Context & challenges in using
  capability for economic evaluation


ICECAP indices: Rome, May 2012


                                 www.birmingham.ac.uk/icecap
The context
o    Decision making across health & other sectors in the
     UK
o    Method required that is individual-based (for use in
     clinical trials/decision analysis)
o    Current approach: QALY maximisation
       – Focus only on health problematic particularly in some areas
             o   Public health
             o   Social care
             o   End of life care


ICECAP indices: Rome, May 2012


                                                      www.birmingham.ac.uk/icecap
The challenge
o    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).
o    ‘Too vague to be of use?’ (Sugden, 1993)


ICECAP indices: Rome, May 2012


                                                       www.birmingham.ac.uk/icecap
The measurement challenge
o    Capabilities or functionings?
o    Participatory methods?
o    Truly ‘objective’ or perceived capabilities?
o    Inclusion of ‘capabilities’ that influence other
     ‘capabilities’
       – E.g. health




ICECAP indices: Rome, May 2012


                                                 www.birmingham.ac.uk/icecap
The valuation challenge
o   Sen rejects use of (individual’s) choices or desires to
    value capabilities – concern with adaptation
o   Other options
      – Deliberation & debate
      – Value judgements elicited from population as ‘evidence’ for
        values (‘Cookson’s compromise’)
o   Anchoring of values
     o    Anchoring considered important in health economics literature so
          as to be able to think about both length & quality of life


ICECAP indices: Rome, May 2012


                                                       www.birmingham.ac.uk/icecap
                      The ICECAP indices



ICECAP indices: Rome, May 2012


                                       www.birmingham.ac.uk/icecap
The measurement challenge: ICECAP
o   Capabilities or functionings?
o   Participatory methods?
      – Used extensively – in-depth qualitative methods to
        determine capabilities
o   Truly ‘objective’ or perceived capabilities?
o   Inclusion of ‘capabilities’ that influence other
    ‘capabilities’
      – Aimed to identify those ‘end-point’ capabilities that are
        fundamentally important to people


ICECAP indices: Rome, May 2012


                                                        www.birmingham.ac.uk/icecap
The valuation challenge: ICECAP
o   Sen rejects use of (individual’s) choices or desires to
    value capabilities – concern with adaptation
o   Other options
      – Deliberation & debate
      – Value judgements elicited from population as ‘evidence’ for
        values (‘Cookson’s compromise’)
o   Anchoring of values
     o    Anchor on ‘full capability’ and ‘no capability’: those who have
          died have no capability on any attribute


ICECAP indices: Rome, May 2012


                                                         www.birmingham.ac.uk/icecap
ICECAP development – all versions
o   Phase 1: in-depth interviews to generate conceptual
    attributes for measures, analysed using constant
    comparative methods
o   Phase 2: semi-structured interviews to check attributes
    and develop meaningful wording for measures
o   Phase 3: valuation using best-worst scaling amongst
    general population
o   Phase 4: assessment of feasibility, validity, reliability,
    sensitivity to change

ICECAP indices: Rome, May 2012


                                                 www.birmingham.ac.uk/icecap
ICECAP




ICECAP indices: Rome, May 2012


                                 www.birmingham.ac.uk/icecap
ICECAP




ICECAP indices: Rome, May 2012


                                 www.birmingham.ac.uk/icecap
ICECAP
                                 o   ICECAP-O
                                     – Older people
                                 o   ICECAP-A
                                     – Adult population
                                 o   ICECAP-SCM
                                     – End of life



ICECAP indices: Rome, May 2012


                                                www.birmingham.ac.uk/icecap
ICECAP-O
5 questions, each with
4 response categories.


1024 possible
‘capability
wellbeing’ states.




     ICECAP indices: Rome, May 2012


                                      www.birmingham.ac.uk/icecap
ICECAP-O index values
                                  o No capability on
                                    all attributes:
                                    value 0
                                  o A little capability
                                    on all attributes:
                                    value 0.556
                                  o A lot of capability
                                    on all attributes:
                                    value 0.868
                                  o Full capability on
                                    all attributes:
                                    value 1




ICECAP indices: Rome, May 2012


                                 www.birmingham.ac.uk/icecap
ICECAP-A
Similar format.


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




    ICECAP indices: Rome, May 2012


                                     www.birmingham.ac.uk/icecap
                                   o   No capability on all attributes: value 0
Preliminary values                 o
                                   o
                                       A little capability on all attributes: value 0.43
                                       A lot of capability on all attributes: value 0.86
                                   o   Full capability on all attributes: value 1




  ICECAP indices: Rome, May 2012


                                                              www.birmingham.ac.uk/icecap
ICECAP-SCM
o    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)
o    2) Being with people who care about you (Being with family, friends or caring
     professionals
o    3) Physical suffering (Experiencing pain or physical discomfort which interferes
     with your daily activities)
o    4) Emotional suffering (Experiencing worry or distress, feeling like a burden)
o     5) Dignity (Being yourself, being clean, having privacy, being treated with
     respect, being spoken to with respect, having your religious or spiritual beliefs
     respected)
o    6) Being supported (Having help and support)
o    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)



ICECAP indices: Rome, May 2012


                                                                   www.birmingham.ac.uk/icecap
              Use of the ICECAP indices



ICECAP indices: Rome, May 2012


                                   www.birmingham.ac.uk/icecap
Included in more than 40 studies




ICECAP indices: Rome, May 2012


                                 www.birmingham.ac.uk/icecap
 Assessing deprivation with ICECAP



ICECAP indices: Rome, May 2012


                                 www.birmingham.ac.uk/icecap
Bristol Research Network presentation 2008
                                             Division of Primary Health Care
Mean ICECAP-O scores: older Bristolians
Male                             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 indices: Rome, May 2012


                                                                www.birmingham.ac.uk/icecap
ICECAP-O multi-variable regression
                                 –   ‘Do not have a faith’ (<0.001)
o   Explaining capability
                                 –   Live alone (0.01)
    wellbeing as                 –   Meeting friends/family daily (0.01)
    measured by                  –   Perceived influence on local
                                     decision making (0.04)
    ICECAP
                                 –   Feeling safe (indoors after dark)
                                     (0.001)
o   Significant
                                 –   Dental care (0.06)
    relationships (10%) in       –   General health (<0.001)
    final model                  –   Housebound for any reason
                                     (<0.001)
                                 –   Disabled (0.01)
                                 –   Sleep quality (0.001)
ICECAP indices: Rome, May 2012


                                                 www.birmingham.ac.uk/icecap
Associations ICECAP-A and health




ICECAP indices: Rome, May 2012


                                 www.birmingham.ac.uk/icecap
Assessing intervention/policy change
           with ICECAP


ICECAP indices: Rome, May 2012


                                 www.birmingham.ac.uk/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 indices: Rome, May 2012


                                                www.birmingham.ac.uk/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 indices: Rome, May 2012


                                                www.birmingham.ac.uk/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 indices: Rome, May 2012


                                                www.birmingham.ac.uk/icecap
                             Further research



ICECAP indices: Rome, May 2012


                                                www.birmingham.ac.uk/icecap
o   Finalise & publish ICECAP-A values
o   Finalise descriptive system for ICECAP-SCM & generate
    values
o   Assessments of validity & reliability for all measures
o   Work on use of measures in studies of efficiency & equity
o   Wealth of qualitative data – better understanding of
    issues such as agency & adaptation


ICECAP indices: Rome, May 2012


                                               www.birmingham.ac.uk/icecap
ICECAP measures
o   Freely available (subject to registration):
     – Downloadable forms at: www.birmingham.ac.uk/icecap
     – Index values
     – Some translations available.
o   Emerging evidence of validity:
     – In general population samples
     – In specific clinical areas.
o   Endorsement from SCIE; interest from other reimbursement
    agencies UK and Netherlands



ICECAP indices: Rome, May 2012


                                                  www.birmingham.ac.uk/icecap
Acknowledgements
o   MRC funding to fully develop
    ICECAP-O, ICECAP-A and early
    development for ICECAP-SCM
o   Large programme of European
    Research Council funding for
    continued work on ICECAP-SCM
o   All collaborators, in particular: Hareth Al-Janabi,
    Terry Flynn, Phil Kinghorn, Rosanna Orlando, Eileen
    Sutton,

ICECAP indices: Rome, May 2012


                                           www.birmingham.ac.uk/icecap
Key references
o   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.
o   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
o   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
o   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.
o   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.
o   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.



ICECAP indices: Rome, May 2012


                                                                            www.birmingham.ac.uk/icecap

								
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