Radboud University Medical Center, Nijmegen, The Netherlands.
Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands.
Soc Sci Med. 2014 Feb;102:83-93. doi: 10.1016/j.socscimed.2013.11.050. Epub 2013 Dec 4.
Gaining health may not be the main goal of healthcare services aimed at older people, which may (also) seek to improve wellbeing. This emphasizes the need of finding appropriate outcome measures for economic evaluation of such services, particularly in long-term care, capturing more than only health-related quality of life (HrQol). This review assesses the usefulness of HrQol and wellbeing instruments for economic evaluations specifically aimed at older people, focusing on generic and preference-based questionnaires measuring wellbeing in particular. We systematically searched six databases and extracted instruments used to assess HrQol and wellbeing outcomes. Instruments were compared based on their usefulness for economic evaluation of services aimed at older people (dimensions measured, availability of utility scores, extent of validation). We identified 487 articles using 34 generic instruments: 22 wellbeing (two of which were preference-based) and 11 HrQol instruments. While standard HrQol instruments measure physical, social and psychological dimensions, wellbeing instruments contain additional dimensions such as purpose in life and achievement, security, and freedom. We found four promising wellbeing instruments for inclusion in economic evaluation: Ferrans and Powers QLI and the WHO-Qol OLD, ICECAP-O and the ASCOT. Ferrans and Powers QLI and the WHO-Qol OLD are widely validated but lack preference-weights while for ICECAP-O and the ASCOT preference-weights are available, but are less widely validated. Until preference-weights are available for the first two instruments, the ICECAP-O and the ASCOT currently appear to be the most useful instruments for economic evaluations in services aimed at older people. Their limitations are that (1) health dimensions may be captured only partially and (2) the instruments require further validation. Therefore, we currently recommend using the ICECAP-O or the ASCOT alongside the EQ-5D or SF-6D when evaluating interventions aimed at older people.
获得健康可能不是针对老年人的医疗保健服务的主要目标，这些服务可能（也）寻求改善幸福感。这强调了需要为这些服务的经济评估找到适当的结果测量方法，特别是在长期护理中，不仅要捕捉与健康相关的生活质量（HrQol）。本综述评估了专门针对老年人的经济评估中使用的 HrQol 和幸福感工具的有用性，特别关注衡量幸福感的通用和基于偏好的问卷。我们系统地搜索了六个数据库，并提取了用于评估 HrQol 和幸福感结果的工具。根据它们在针对老年人的服务经济评估中的有用性，对工具进行了比较（测量的维度、效用得分的可用性、验证的程度）。我们使用 34 种通用工具确定了 487 篇文章：22 种幸福感（其中两种基于偏好）和 11 种 HrQol 工具。虽然标准的 HrQol 工具测量身体、社会和心理维度，但幸福感工具包含了额外的维度，如生活目标和成就、安全感和自由。我们发现了四种有前途的幸福感工具，可纳入经济评估：Ferrans 和 Powers QLI 和 WHO-Qol OLD、ICECAP-O 和 ASCOT。Ferrans 和 Powers QLI 和 WHO-Qol OLD 得到了广泛验证，但缺乏偏好权重，而对于 ICECAP-O 和 ASCOT，偏好权重可用，但验证范围较窄。在为前两种工具提供偏好权重之前，目前看来，ICECAP-O 和 ASCOT 是针对老年人服务的经济评估中最有用的工具。它们的局限性在于：（1）健康维度可能仅部分捕获，（2）这些工具需要进一步验证。因此，当评估针对老年人的干预措施时，我们目前建议同时使用 ICECAP-O 或 ASCOT 以及 EQ-5D 或 SF-6D。
