Mitchell Paul Mark, Venkatapuram Sridhar, Richardson Jeff, Iezzi Angelo, Coast Joanna
Health Economics at Bristol (HEB), School of Social and Community Medicine, University of Bristol, Bristol, UK.
The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Pharmacoeconomics. 2017 Jun;35(6):637-646. doi: 10.1007/s40273-017-0495-3.
There is a debate in the health economics literature concerning the most appropriate way of applying Amartya Sen's capability approach in economic evaluation studies. Some suggest that quality-adjusted life years (QALYs) alone are adequate while others argue that this approach is too narrow and that direct measures of capability wellbeing provide a more extensive application of Sen's paradigm.
This paper empirically explores whether QALYs provide a good proxy for individual capabilities.
Data is taken from a multinational cross-sectional survey of individuals with seven health conditions (asthma, arthritis, cancer, depression, diabetes, hearing loss, heart disease) and a healthy population. Each individual completed the ICECAP-A measure of capability wellbeing for adults and six health utility instruments that are used to generate QALYs, including EQ-5D and SF-6D. Primary analysis examines how well health utility instruments can explain variation in the ICECAP-A using ordinary least squares regression.
The findings show that all seven health conditions have a negative association on overall capability as measured by the ICECAP-A index. Inclusion of health utility instruments into separate regressions improves the predictive power of capability but on average, explains less than half of the variation in capability wellbeing. Individuals with arthritis appear to be less inhibited in terms of capability losses when accounting for health utility, yet those who have depression record significant reductions in capability relative to the healthy population even after accounting for the most commonly used health utility instruments.
The study therefore casts doubt on the ability of QALYs to act as a reliable proxy measure of individuals' capability.
卫生经济学文献中存在一场关于在经济评估研究中应用阿玛蒂亚·森的能力方法的最合适方式的辩论。一些人认为仅质量调整生命年（QALYs）就足够了，而另一些人则认为这种方法过于狭隘，能力福祉的直接衡量为森的范式提供了更广泛的应用。
本文实证探究QALYs是否能很好地代表个人能力。
数据取自对患有七种健康状况（哮喘、关节炎、癌症、抑郁症、糖尿病、听力损失、心脏病）的个体以及健康人群的跨国横断面调查。每个个体完成了用于衡量成人能力福祉的ICECAP - A量表以及六种用于生成QALYs的健康效用工具，包括EQ - 5D和SF - 6D。主要分析使用普通最小二乘法回归来检验健康效用工具能多好地解释ICECAP - A中的差异。
研究结果表明，根据ICECAP - A指数衡量，所有七种健康状况与总体能力呈负相关。将健康效用工具纳入单独的回归分析提高了对能力的预测能力，但平均而言，解释的能力福祉差异不到一半。考虑健康效用时，患有关节炎的个体在能力损失方面似乎受影响较小，然而，即使考虑了最常用的健康效用工具，患有抑郁症的个体相对于健康人群的能力仍有显著下降。
因此，该研究对QALYs能否作为个体能力的可靠替代指标提出了质疑。
