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QALYs and the capability approach.

Richard Cookson1

  • 1School of Medicine, Health Policy and Practice, University of East Anglia, UK. rc503@york.ac.uk r.cookson@uea.ac.uk

Health Economics
|February 5, 2005
PubMed
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This study examines applying Sen's capability approach to healthcare economic evaluations. Reinterpreting the Quality-Adjusted Life Year (QALY) offers a practical, though imperfect, method to value health capabilities and functionings.

Area of Science:

  • Health Economics
  • Social Choice Theory
  • Amartya Sen's Capability Approach

Background:

  • Economic evaluation of healthcare programs often uses preference-based methods like willingness to pay.
  • These methods face challenges due to adaptive preferences and uncertainty.
  • Sen's capability approach offers an alternative framework focusing on freedoms and functionings.

Purpose of the Study:

  • To explore the applicability of Sen's capability approach to economic evaluations in healthcare.
  • To assess the feasibility of directly estimating and valuing capability sets.
  • To re-interpret the Quality-Adjusted Life Year (QALY) within the capability framework.

Main Methods:

  • Conceptual analysis of Sen's capability approach and its relation to health valuation.

Related Experiment Videos

  • Critique of standard preference-based valuation methods (e.g., willingness to pay).
  • Re-interpretation of QALYs as an index of capability set value, considering functionings.

    • Main Results:

    • Direct estimation of capability sets is currently infeasible.
    • Preference-based methods are problematic due to preference instability.
    • QALYs, when re-interpreted, can serve as a cardinal and interpersonally comparable index of capability value.
    • The QALY approach aligns with the capability approach by focusing on functionings and allowing non-utilitarian values.

    Conclusions:

    • The QALY approach, despite limitations, can be recognized as an application of the capability approach in healthcare evaluation.
    • This re-interpretation allows for consideration of non-health components, process attributes (like dignity), and subgroup diversity.
    • Further modifications can enhance the QALY's ability to capture broader aspects of well-being relevant to the capability approach.