Strategies for the economic evaluation of end-of-life care: making a case for the capability approach

Abstract

Economic evaluation of end of life care is increasingly expected from both research funders and those making decisions about the use of health and social care resources. There are, however, difficulties in applying the currently established evaluative methods to end of life. These are partly associated with the sensitivity of the topic and the feasibility of data collection but also, more fundamentally, a lack of agreement about the terms in which such care should be evaluated. This paper examines different theoretical perspectives from which economic evaluation of end of life care could be conducted, and argues for the application of a capability approach focusing on the opportunity for a good death. It then examines challenges with taking forward such an approach, including defining, measuring and valuing appropriate outcomes. It concludes that such an approach is viable, and explores how it might be taken forward to assist with resource allocation decisions.

Bringing the economic cost of informal caregiving into focus

“…Furthermore, as Bremner and colleagues illustrated, little or no informal caregiver data are routinely collected in healthcare administrative databases and acquiring such data prospectively requires additional resourcing. Finally, there are unresolved philosophical, theoretical and methodological issues such as the appropriate evaluative space (utility, health, capability), 10 how to allocate the costs of joint activities and care specific to palliation, the choice of informal caregiver outcome measure and accounting for interdependent and potentially conflicting patient and caregiver preferences. 2 Economic evaluations in the palliative and end-of-life care setting are rare and seldom include informal caregiver costs and outcomes.…”

Complex Valuation: Applying Ideas from the Complex Intervention Framework to Valuation of a New Measure for End-of-Life Care

“…The aim was to pursue the extra-welfarist approach [14,15] [17]), it may be difficult to obtain values from these individuals due to their physical and emotional vulnerability. It is particularly important to know whether values differ between these two groups, and so a major aspect of the design task was to generate a design that could, in time, facilitate such comparison.…”

Measuring Health and Broader Well-Being Benefits in the Context of Opiate Dependence: The Psychometric Performance of the ICECAP-A and the EQ-5D-5L

“…It is designed to measure a core set of domains believed to impact on quality of life and linked to health. However, with this focus on certain aspects of health, the EQ-5D may not adequately reflect the impact of all health care interventions [10], such as for hearing or vision disorders [11], and severe mental health problems [12], and particularly of those resulting in broader personal and interpersonal wellbeing benefits, such as public health and social care interventions [13][14][15][16][17][18][19]. An alternative framework for measuring treatment benefits is with the ICEpop CAPability (ICECAP) measures, underpinned by Amartya Sen's capability approach [20].…”