Developing an Index of Capability for Older People: A New Form of Measure for Public Health Interventions?

Economic evaluation requires monetary measures or a single outcome for use across all interventions to assist decisions about service provision. Monetary values can be estimated through willingness to pay methods but there are difficulties, with few analyses successfully using these methods to value all outcomes (Drummond et al., 2005). Instead, economic evaluation most often uses a single outcome. The quality-adjusted life-year (QALY), as recommended by the National Institute for Health and Clinical Excellence (NICE) in the UK (NICE, 2004), has become the dominant measure within economic evaluation. QALYs may be formed from a number of different measures, including the EQ-5D (Brooks, 1996), the SF-36 (Brazier et al., 2002) and the Health Utility Index (Horsman et al., 2003), but all focus entirely on health as the outcome of interest. The majority of analyses in the UK are currently conducted using EQ-5D, a measure with five dimensions (mobility, self-care, usual activities, pain/discomfort and anxiety/depression) each with three levels (Brooks, 1996).