Outcomes Measurement for Economic Evaluation

Chapter

Abstract

Benefits or outcomes are used in economic evaluation to assess welfare maximization or health gain, depending on theoretical view – whether its a welfarist or extra-welfarist perspective. On the other hand, the measurement of health outcomes are usually related to clinical symptoms, physical functioning, and quality of life. In the Mental Health field, using exclusively clinical outcomes is not appropriate to capture all benefits obtained from treatments. Social and psychological dimensions are also crucial components to evaluate mental health gains. In economic evaluation, the choice of outcome should be based on the relevance to the patient’s health and quality of life. Therefore, several challenges exist in defining the best mental health outcome in economic evaluation. In an extra-welfarist approach, outcomes in economic evaluation are classified into two main groups: one not based on client preferences (so-called measures), and a second based on client preferences (so-called values). Methods for assessing measures are scales based on specific and nonspecific disease symptoms. Methods for assessing outcome values are standard gamble, time trade-off, rating scales, and ratio scales. Only standard gamble assesses utility because it involves preferences based on uncertainty. The person trade-off method and multiattribute tools use expert panels and indirect methods, respectively, to assess outcome values. The capability approach has recently emerged as a new alternative to welfarist approach, focusing in broader measurement of outcomes related to individual’s capability and quality of life. This concept was operationalized into a multidimensional instrument for the Mental Health field: ICECAP-MH. In the welfarist approach, outcomes are expressed in monetary units and assessed mainly by contingent valuation (CV; willingness-to-pay method) and discrete experiment choice. This chapter describes these methods and discusses their advantages and disadvantages for economic evaluation in the Mental Health field.

References

  1. 1.
    Birch S, Donaldson C. Valuing the benefits and costs of health care programmes: where’s the ‘extra’ in extra-welfarism? Soc Sci Med. 2003;56(5):1121–33.CrossRefPubMedGoogle Scholar
  2. 2.
    Brouwer WB, Culyer AJ, van Exel NJ, Rutten FF. Welfarism vs. extra-welfarism. J Health Econ. 2008;27(2):325–38.CrossRefPubMedGoogle Scholar
  3. 3.
    Brazier JE, Dixon S, Ratcliffe J. The role of patient preferences in cost-effectiveness analysis: a conflict of values? PharmacoEconomics. 2009;27(9):705–12.CrossRefPubMedGoogle Scholar
  4. 4.
    Byford S, Sefton T. Economic evaluation of complex health and social care interventions. Natl Inst Econ Rev. 2003;186:98–108.CrossRefGoogle Scholar
  5. 5.
    Coast J. Is economic evaluation in touch with society’s health values? BMJ. 2004;329(7476):1233–6.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Coast J. Maximisation in extra-welfarism: a critique of the current position in health economics. Soc Sci Med. 2009;69(5):786–92.CrossRefPubMedGoogle Scholar
  7. 7.
    Knapp M. Economic outcomes and levers: impacts for individuals and society. Int Psychogeriatr. 2007;19(3):483–95.CrossRefPubMedGoogle Scholar
  8. 8.
    Drummond M, McGuire A. Economic evaluation in health care: merging theory with practice. 2nd ed. New York: Oxford University Press; 2004.Google Scholar
  9. 9.
    Drummond MF, Sculpher MJ, Torrance GW, O’Brien BJ, Stoddart GL. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press; 2007.Google Scholar
  10. 10.
    Dolan P. Utilitarianism and the measurement and aggregation of quality – adjusted life years. Health Care Anal. 2001;9(1):65–76.CrossRefPubMedGoogle Scholar
  11. 11.
    Dolan PA, Olsen JA. Equity in health: the importance of different health streams. J Health Econ. 2001;20(5):823–34.CrossRefPubMedGoogle Scholar
  12. 12.
    Olsen JA, Smith RD. Theory versus practice: a review of ‘willingness-to-pay’ in health and health care. Health Econ. 2001;10(1):39–52.CrossRefPubMedGoogle Scholar
  13. 13.
    Thornicroft G, Tansella M. Mental health outcomes measures. 3rd ed. Glasgow: RC Psych Publications; 2010.Google Scholar
  14. 14.
    Brazier J. Measuring and valuing mental health for use in economic evaluation. J Health Serv Res Policy. 2008;13(Suppl3):70–5.CrossRefPubMedGoogle Scholar
  15. 15.
    Gray A, Clarke P, Wolstenholme J, Worsworth S. Applied methods of cost-effectiveness analysis in health care. 1st ed. Oxford: Oxford University Press; 2011.Google Scholar
  16. 16.
    Coast J, Kinghorn P, Mitchell P. The development of capability measures in health economics: opportunities, challenges and progress. Patient. 2015;8(2):119–26.CrossRefPubMedGoogle Scholar
  17. 17.
    Mitchell PM, Al-Janabi H, Richardson J, Iezzi A, Coast J. The relative impacts of disease on health status and capability wellbeing: a multi-country study. PLoS One. 2015;10(12):e0143590.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Mitchell PM, Roberts TE, Barton PM, Coast J. Assessing sufficient capability: a new approach to economic evaluation. Soc Sci Med. 2015;139:71–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Simon J, Anand P, Gray A, Rugkasa J, Yeeles K, Burns T. Operationalising the capability approach for outcome measurement in mental health research. Soc Sci Med. 2013;98:187–96.CrossRefPubMedGoogle Scholar
  20. 20.
    Mortimer D, Segal L. Comparing the incomparable? A systematic review of competing techniques for converting descriptive measures of health status into QALY-weights. Med Decis Mak. 2008;28:66–89.CrossRefGoogle Scholar
  21. 21.
    Dolan P, Kahneman D. Interpretations of utility and their implications for the valuation of health. Econ J. 2008;118:215–34.CrossRefGoogle Scholar
  22. 22.
    Dolan P, Metcalfe R. Valuing health: a brief report on subjective well-being versus preferences. Med Decis Mak. 2012;32(4):578–82.CrossRefGoogle Scholar
  23. 23.
    Versteegh MM, Brouwer WB. Patient and general public preferences for health states: a call to reconsider current guidelines. Soc Sci Med. 2016;165:66–74.CrossRefPubMedGoogle Scholar
  24. 24.
    Torrance GW. Utility approach to measuring health-related quality of life. J Chronic Dis. 1987;40(6):593–603.CrossRefPubMedGoogle Scholar
  25. 25.
    Von Neuman J, Morgenstein O. Theory of games and economic behavior. Princeton: Princeton University Press; 1944.Google Scholar
  26. 26.
    Prades J. Is the person trade off a valid method for allocating health care resources? Health Econ. 1997;6:71–81.CrossRefGoogle Scholar
  27. 27.
    Bennett KJ. Development and testing of a utility measure for major, unipolar depression (McSad). 2000Google Scholar
  28. 28.
    Kahneman D, Tversky A. Choices, values and frames. Am Psychol. 1984;39(4):341–50.CrossRefGoogle Scholar
  29. 29.
    Bleichrodt H, Johannesson M. Standard gamble, time trade-off and rating scale: experimental results on the ranking properties of QALYs. J Health Econ. 1997;16(2):155–75.CrossRefPubMedGoogle Scholar
  30. 30.
    Froberg DG, Kane RL. Methodology for measuring health-state preferences–II: scaling methods. J Clin Epidemiol. 1989;42(5):459–71.CrossRefGoogle Scholar
  31. 31.
    Konig H, Gunther O, Angrmeyer M, Roick C. Utility assessment in patient with mental disorders: validity and discriminative ability of the time trade off method. PharmacoEconomics. 2009;27(5):405–19.CrossRefPubMedGoogle Scholar
  32. 32.
    Brazier J, Deverill M, Green C. A review of the use of health status measures in economic evaluation. J Health Serv Res Policy. 1999;4(3):174–84.CrossRefPubMedGoogle Scholar
  33. 33.
    Bennett KJ, Torrance GW, Boyle MH, Guscott R. Cost-utility analysis in depression: the McSad utility measure for depression health states. Psychiatr Serv. 2000;51(9):1171–6.CrossRefGoogle Scholar
  34. 34.
    Torrance GW, Feeny D, Furlong W. Visual analog scales: do they have a role in the measurement of preferences for health states? Med Decis Mak. 2001;21(4):329–34.CrossRefGoogle Scholar
  35. 35.
    Voruganti LN, Awad AG, Oyewumi LK, Cortese L, Zirul S, Dhawan R. Assessing health utilities in schizophrenia. A feasibility study. PharmacoEconomics. 2000;17(3):273–86.CrossRefGoogle Scholar
  36. 36.
    Lenert LA, Sturley AP, Rapaport MH, Chavez S, Mohr PE, Rupnow M. Public preferences for health states with schizophrenia and a mapping function to estimate utilities from positive and negative symptom scale scores. Schizophr Res. 2004;71(1):155–65.CrossRefPubMedGoogle Scholar
  37. 37.
    Revicki DA, Wood M. Patient-assigned health state utilities for depression-related outcomes: differences by depression severity and antidepressant medications. J Affect Disord. 1998;48(1):25–36.CrossRefPubMedGoogle Scholar
  38. 38.
    Briggs A, Wild D, Lees M, Reaney M, Dursun S, Parry D, et al. Impact of schizophrenia and schizophrenia treatment-related adverse events on quality of life: direct utility elicitation. Health Qual Life Outcomes. 2008;6:105.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Revicki DA, Hanlon J, Martin S, Gyulai L, Nassir GS, Lynch F, et al. Patient-based utilities for bipolar disorder-related health states. J Affect Disord. 2005;87(2–3):203–10.CrossRefPubMedGoogle Scholar
  40. 40.
    Nord E. The person trade-off approaching to valuing health care programs. Med Decis Mak. 1995;15(3):201–8.CrossRefGoogle Scholar
  41. 41.
    Arnesen T, Nord E. The value of DALY life: problems with ethics and validity of disability adjusted life years. BMJ. 1999;319(7222):1423–5.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Kopec JA, Willison KD. A comparative review of four preference-weighted measures of health-related quality of life. J Clin Epidemiol. 2003;56(4):317–25.CrossRefPubMedGoogle Scholar
  43. 43.
    Richardson J, Khan MA, Iezzi A, Maxwell A. Comparing and explaining differences in the magnitude, content, and sensitivity of utilities predicted by the EQ-5D, SF-6D, HUI 3, 15D, QWB, and AQoL-8D multiattribute utility instruments. Med Decis Mak. 2015;35(3):276–91.CrossRefGoogle Scholar
  44. 44.
    The EuroQol Group. EuroQol: a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.CrossRefGoogle Scholar
  45. 45.
    Lamers LM, Bouwmans CA, van Straten A, Donker MC, Hakkaart L. Comparison of EQ-5D and SF-6D utilities in mental health patients. Health Econ. 2006;15(11):1229–36.CrossRefPubMedGoogle Scholar
  46. 46.
    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.CrossRefPubMedGoogle Scholar
  47. 47.
    Walters SJ, Brazier JE. Comparison of the minimally important difference for two health state utility measures: EQ-5D and SF-6D. Qual Life Res. 2005;14(6):1523–32.CrossRefPubMedGoogle Scholar
  48. 48.
    McDonough CM, Tosteson AN. Measuring preferences for cost-utility analysis: how choice of method may influence decision-making. PharmacoEconomics. 2007;25(2):93–106.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Brazier J. Is the EQ-5D fit for purpose in mental health? Br J Psychiatry. 2010;197(5):348–9.CrossRefPubMedGoogle Scholar
  50. 50.
    Brazier J, Connell J, Papaioannou D, Mukuria C, Mulhern B, Peasgood T, et al. A systematic review, psychometric analysis and qualitative assessment of generic preference-based measures of health in mental health populations and the estimation of mapping functions from widely used specific measures. Health Technol Assess. 2014;18(34):vii–xxv.CrossRefGoogle Scholar
  51. 51.
    Papaioannou D, Brazier J, Parry G. How valid and responsive are generic health status measures, such as EQ-5D and SF-36, in schizophrenia? A systematic review. Value Health. 2011;14(6):907–20.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Mavranezouli I, Brazier JE, Rowen D, Barkham M. Estimating a preference-based index from the clinical outcomes in routine evaluation-outcome measure (CORE-OM): valuation of CORE-6D. Med Decis Mak. 2013;33(3):381–95.CrossRefGoogle Scholar
  53. 53.
    Gafni A. Willingness to pay in the context of an economic evaluation of healthcare programs: theory and practice. Am J Manag Care. 1997;3(Suppl):S21–32.PubMedGoogle Scholar
  54. 54.
    Klose T. The contingent valuation method in health care. Health Policy. 1999;47(2):97–123.CrossRefPubMedGoogle Scholar
  55. 55.
    Diener A, O’Brien B, Gafni A. Health care contingent valuation studies: a review and classification of the literature. Health Econ. 1998;7(4):313–26.CrossRefPubMedGoogle Scholar
  56. 56.
    Ryan M, Watson V, Amaya-Amaya M. Methodological issues in the monetary valuation of benefits in healthcare. Expert Rev Pharmacoecon Outcomes Res. 2003;3(6):717–27.CrossRefPubMedGoogle Scholar
  57. 57.
    Quevedo J, Contreras Hernández I, Espinosa JG, scuderoII G. The willingness-to-pay concept in question. Rev Saude Publica. 2009:43(2).Google Scholar
  58. 58.
    McIntosh E, Donaldson C, Ryan M. Recent advances in the methods of cost-benefit analysis in healthcare. Matching the art to the science. PharmacoEconomics. 1999;15(4):352–58.CrossRefGoogle Scholar
  59. 59.
    Smith DM, Damschroder LJ, Kim SY, Ubel PA. What’s it worth? Public willingness to pay to avoid mental illnesses compared with general medical illnesses. Psychiatr Serv. 2012;63(4):319–24.CrossRefPubMedGoogle Scholar
  60. 60.
    Franklin M. The role of utility, health, and capabilities in economic evaluation: a case study in frail older people. Nottingham: The University of Nottingham; 2016.Google Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  1. 1.Centre of Economic Mental Health (CESM), Department of PsychiatryUniversidade Federal de Sao PauloSão PauloBrazil

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