Using the ICECAP
indices to measure
capability wellbeing
in the UK
Joanna Coast
Rome, May 2012
Outline

Context & challenges in using capability for
economic evaluation

The ICECAP indices

Use of the ICECAP indices
– To assess deprivation
– To assess intervention/policy change

Further research
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
Context & challenges in using
capability for economic evaluation
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
The context

Decision making across health & other sectors in the
UK

Method required that is individual-based (for use in
clinical trials/decision analysis)

Current approach: QALY maximisation
– Focus only on health problematic particularly in some areas



Public health
Social care
End of life care
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
The challenge

Deliberately underspecified nature of the capability
approach (Sen, 1993)
– ‘Quite different specific theories of value may be consistent
with the capability approach, and share the common feature
of selecting value-objects from functionings and capabilities.
Further, the capability approach can be used with different
methods of determining relative weights and different
mechanisms for actual evaluation.’ (Sen, 1993) (p. 48).

‘Too vague to be of use?’ (Sugden, 1993)
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
The measurement challenge

Capabilities or functionings?

Participatory methods?

Truly ‘objective’ or perceived capabilities?

Inclusion of ‘capabilities’ that influence other
‘capabilities’
– E.g. health
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
The valuation challenge

Sen rejects use of (individual’s) choices or desires to
value capabilities – concern with adaptation

Other options
– Deliberation & debate
– Value judgements elicited from population as ‘evidence’ for
values (‘Cookson’s compromise’)

Anchoring of values

Anchoring considered important in health economics literature so
as to be able to think about both length & quality of life
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
The ICECAP indices
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
The measurement challenge: ICECAP

Capabilities or functionings?

Participatory methods?
– Used extensively – in-depth qualitative methods to
determine capabilities

Truly ‘objective’ or perceived capabilities?

Inclusion of ‘capabilities’ that influence other
‘capabilities’
– Aimed to identify those ‘end-point’ capabilities that are
fundamentally important to people
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
The valuation challenge: ICECAP

Sen rejects use of (individual’s) choices or desires to
value capabilities – concern with adaptation

Other options
– Deliberation & debate
– Value judgements elicited from population as ‘evidence’ for
values (‘Cookson’s compromise’)

Anchoring of values

Anchor on ‘full capability’ and ‘no capability’: those who have
died have no capability on any attribute
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
ICECAP development – all versions

Phase 1: in-depth interviews to generate conceptual
attributes for measures, analysed using constant
comparative methods

Phase 2: semi-structured interviews to check attributes
and develop meaningful wording for measures

Phase 3: valuation using best-worst scaling amongst
general population

Phase 4: assessment of feasibility, validity, reliability,
sensitivity to change
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
ICECAP
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
ICECAP
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
ICECAP

ICECAP-O
– Older people

ICECAP-A
– Adult population

ICECAP-SCM
– End of life
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
ICECAP-O
5 questions, each with
4 response categories.
1024 possible
‘capability
wellbeing’ states.
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
ICECAP-O index values

Control
Enjoyment
4
3
Role
2
1
Security
Attachment
-0.1
0
0.1
0.2
No capability on
all attributes:
value 0
 A little capability
on all attributes:
value 0.556
 A lot of capability
on all attributes:
value 0.868
 Full capability on
all attributes:
value 1
0.3
Values rescaled such that 11111 equals zero and
44444 equals one
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
ICECAP-A
Similar format.
Aims to tap into some
domains of importance
to general adult
population not captured
in ICECAP-O.
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap




Preliminary values
No capability on all attributes: value 0
A little capability on all attributes: value 0.43
A lot of capability on all attributes: value 0.86
Full capability on all attributes: value 1
Preliminary UK index values for ICECAP-A
0.25
index value
0.2
0.15
0.1
0.05
0
L1
-0.05
L2
L3
Stability
L4
L1
L2
L3
Attachment
L4
L1
L2
L3
Autonomy
Attribute
L4
L1
L2
L3
L4
Achievement
L1
L2
L3
L1
Enjoyment
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
ICECAP-SCM

1) Having a say (Your ability to influence where you would like to live or be
cared for, the kind of treatment you receive, the people who care for you)

2) Being with people who care about you (Being with family, friends or caring
professionals

3) Physical suffering (Experiencing pain or physical discomfort which interferes
with your daily activities)

4) Emotional suffering (Experiencing worry or distress, feeling like a burden)

5) Dignity (Being yourself, being clean, having privacy, being treated with
respect, being spoken to with respect, having your religious or spiritual beliefs
respected)

6) Being supported (Having help and support)

7) Being prepared (Having financial affairs in order, having your funeral
planned, saying goodbye to family and friends, resolving things that are
important to you, having treatment preferences in writing or making a living will)
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
Use of the ICECAP indices
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
Included in more than 40 studies
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
Assessing deprivation with ICECAP
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
Bristol Research Network presentation 2008
Division of Primary Health Care
Mean ICECAP-O scores: older Bristolians
Male
Female
Age 65-74
Age 75+
White
BME
Have a faith
No faith
Not carer
Carer
Receive benefits
Do not receive benefits
Benefits N/A
0.837
0.826
0.838
0.819
0.832
0.808
0.836
0.803
0.836
0.800
0.777
0.844
0.851
General health good
GH fairly good
GH not good
0.882
0.835
0.725
Live alone
Live with others
Dental care: NHS
Dental care: private
Dental care: none
0.809
0.842
0.828
0.869
0.798
Have qualification
Not have qualification
0.855
0.817
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
ICECAP-O multi-variable regression


Explaining capability
wellbeing as
measured by
ICECAP
–
–
–
–
Significant
relationships (10%) in
final model
–
–
–
–
–
–
‘Do not have a faith’ (<0.001)
Live alone (0.01)
Meeting friends/family daily (0.01)
Perceived influence on local
decision making (0.04)
Feeling safe (indoors after dark)
(0.001)
Dental care (0.06)
General health (<0.001)
Housebound for any reason
(<0.001)
Disabled (0.01)
Sleep quality (0.001)
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
Associations ICECAP-A and health
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
Assessing intervention/policy change
with ICECAP
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
Change following treatment (n=56)
Coefficient
se Lower Upper
ICECAP-O score
0.070
0.016 0.038 0.102
Change in individual index values (on 0-1 scale)
Attachment
-0.010
0.006 -0.022 0.002
Security
0.021
0.007 0.007 0.035
Role
0.017
0.005 0.008 0.027
Enjoyment
0.020
0.005 0.011 0.029
Control
0.021
0.005
0.012 0.031
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
Change following treatment (n=56)
Coefficient
se Lower Upper
ICECAP-O score
0.070
0.016 0.038 0.102
Change in individual index values (on 0-1 scale)
Attachment
-0.010
0.006 -0.022 0.002
Security
0.021
0.007 0.007 0.035
Role
0.017
0.005 0.008 0.027
Enjoyment
0.020
0.005 0.011 0.029
Control
0.021
0.005
0.012 0.031
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
Change following treatment (n=56)
Coefficient
se Lower Upper
ICECAP-O score
0.070
0.016 0.038 0.102
Change in individual index values (on 0-1 scale)
Attachment
-0.010
0.006 -0.022 0.002
Security
0.021
0.007 0.007 0.035
Role
0.017
0.005 0.008 0.027
Enjoyment
0.020
0.005 0.011 0.029
Control
0.021
0.005
0.012 0.031
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
Further research
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap

Finalise & publish ICECAP-A values

Finalise descriptive system for ICECAP-SCM & generate
values

Assessments of validity & reliability for all measures

Work on use of measures in studies of efficiency & equity

Wealth of qualitative data – better understanding of
issues such as agency & adaptation
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
ICECAP measures

Freely available (subject to registration):
– Downloadable forms at: www.birmingham.ac.uk/icecap
– Index values
– Some translations available.

Emerging evidence of validity:
– In general population samples
– In specific clinical areas.

Endorsement from SCIE; interest from other reimbursement
agencies UK and Netherlands
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
Acknowledgements

MRC funding to fully develop
ICECAP-O, ICECAP-A and early
development for ICECAP-SCM

Large programme of European
Research Council funding for
continued work on ICECAP-SCM

All collaborators, in particular: Hareth Al-Janabi,
Terry Flynn, Phil Kinghorn, Rosanna Orlando, Eileen
Sutton,
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap
Key references

Grewal I, Lewis J, Flynn T, Brown J, Bond, J, Coast J. Developing attributes for a generic quality of
life measure for older people: preferences or capabilities? Social Science and Medicine.
2006;62(8):1891-1901.

Coast J, Flynn TN, Natarajan L, Sproston K, Lewis J, Louviere JJ, Peters TJ. Valuing the ICECAP
capability index for older people. Social Science & Medicine. 2008;67:874-882

Coast J, Peters TJ, Natarajan L, Sproston K, Flynn TN. An assessment of the construct validity of
the descriptive system for the ICECAP capability measure for older people. Quality of Life
Research. 2008;17;967-976

Flynn TN, Chan P, Coast J, Peters TJ. Assessing quality of life among British older people using
the ICECAP-O capability measure. Applied Health Economics and Health Policy. 2011;9(5):317-329.

Makai P, Brouwer WB, Koopmanschap MA, Nieboer AP. Capabilities and quality of life in Dutch
psycho-geriatric nursing homes: an exploratory study using a proxy version of the ICECAP-O.
Quality of Life Research 2012;21(5):801-12.

Al-Janabi H, Flynn T, Coast J. Development of a self-report measure of capability wellbeing for
adults: the ICECAP-A. Quality of Life Research. 2012; 21:167–176.
ICECAP indices: Rome, May 2012
www.birmingham.ac.uk/icecap