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Methods for measuring outcomes suitable for economic evaluations of health and care interventions have primarily focused on adults. The validity of such methods for children and young people is questionable in areas including the outcome domains measured and how they are measured and valued, with most existing measures narrowly focusing on health. Novel methods for assessing benefits beyond health by focusing on a person's capability have also concentrated on adults to date. This paper aims to set out the rationale for capability measures in children and young people. It argues for the need to expand the evaluative space beyond health functioning towards broader capabilities, with children and young people playing an integral role in capability measure development. Drawing from existing literature, specific challenges related to the identification, measurement, and valuation of capabilities in children and young people are also discussed. Finally, the practical implications for conducting economic evaluation when measuring and valuing capabilities at different stages across the life-course are illustrated. We develop an alternative framework based on conceiving capabilities as evolving across the life-course. This framework may also be helpful in thinking about how to model health outcomes across the life-course., (© 2021 The Authors. Health Economics published by John Wiley & Sons Ltd.)

The capability approach is potentially valuable for economic evaluation at the end of life because of its conceptualization of wellbeing as freedom and the potential for capturing outcomes for those at end of life and those close to persons at the end of life. For decision making, however, this information needs to be integrated into current evaluation paradigms. This research explored weights for an integrated economic evaluation framework using a deliberative approach. Twelve focus groups were held (38 members of the public, 29 "policy makers," seven hospice volunteers); budget pie tasks were completed to generate weights. Constant comparison was used to analyze qualitative data, exploring principles behind individuals' weightings. Average weights elicited from members of the general population and policy makers for the importance that should be given to close persons (vs. patients) were very similar, at around 30%. A "sliding scale" of weights between health gain and the capability for a good death resulted from the policy maker and volunteer groups, with increasing weight given to the capability for a good death as the trajectory got closer to death. These weights can be used in developing a more comprehensive framework for economic evaluation at end of life., (© 2021 The Authors. Health Economics published by John Wiley & Sons Ltd.)

The friction cost approach has been proposed as an alternative to the human capital approach in estimating productivity costs. However, it is difficult, in practice, to apply this approach due to limited availability of context-specific data. Using national and firm-level data on vacancy durations sourced from 4 organisations, we estimated vacancy durations, and consequently, length of friction period for the United Kingdom disaggregated by occupational classification. We found comparable estimates to previously reported friction periods elsewhere. The disaggregated friction period analysis confirmed occupational class has an effect on the estimated length of the friction period. The research presents estimates on vacancy durations and friction periods necessary to use the friction cost approach in a practical way in economic evaluations., (Copyright © 2017 John Wiley & Sons, Ltd.)

The health of carers and others close to the patient will often be relevant to economic evaluation, but it is very rarely considered in practice. This may reflect a lack of understanding of how the spillover effect of illness can be appropriately quantified. In this study we used three different approaches to quantify health spillovers resulting from meningitis. We conducted a survey of 1218 family networks affected by meningitis and used regression modelling to estimate spillover effects. The findings show that meningitis had long-term effects on family members' health, particularly affecting the likelihood of family members reporting anxiety and depression. These effects extended beyond a single close family member. These findings suggest that vaccinating against meningitis will bring significant health benefits not just to those that might have contracted the illness but also to their family networks. In methodological terms, different approaches for quantifying health spillovers provided broadly consistent results. The choice of method will be influenced by the ease of collecting primary data from family members in intervention contexts. © 2015 The Authors. Health Economics published by John Wiley & Sons Ltd., (© 2015 The Authors. Health Economics published by John Wiley & Sons Ltd.)

Although philosophically attractive, it may be difficult, in practice, to measure individuals' capabilities (what they are able to do in their lives) as opposed to their functionings (what they actually do). To examine whether capability information could be reliably self-reported, we administered a measure of self-reported capability (the Investigating Choice Experiments Capability Measure for Adults, ICECAP-A) on two occasions, 2 weeks apart, alongside a self-reported health measure (the EuroQol Five Dimensional Questionnaire with 3 levels, EQ-5D-3L). We found that respondents were able to report capabilities with a moderate level of consistency, although somewhat less reliably than their health status. The more socially orientated nature of some of the capability questions may account for the difference., (© 2014 The Authors Health Economics published by John Wiley & Sons Ltd.)

This paper reports the results of a best-worst scaling (BWS) study to value the Investigating Choice Experiments Capability Measure for Adults (ICECAP-A), a new capability measure among adults, in a UK setting. A main effects plan plus its foldover was used to estimate weights for each of the four levels of all five attributes. The BWS study was administered to 413 randomly sampled individuals, together with sociodemographic and other questions. Scale-adjusted latent class analyses identified two preference and two (variance) scale classes. Ability to characterize preference and scale heterogeneity was limited, but data quality was good, and the final model exhibited a high pseudo-r-squared. After adjusting for heterogeneity, a population tariff was estimated. This showed that 'attachment' and 'stability' each account for around 22% of the space, and 'autonomy', 'achievement' and 'enjoyment' account for around 18% each. Across all attributes, greater value was placed on the difference between the lowest levels of capability than between the highest. This tariff will enable ICECAP-A to be used in economic evaluation both within the field of health and across public policy generally., (© 2013 The Authors. Health Economics published by John Wiley & Sons Ltd.)

Attribute generation for discrete choice experiments (DCEs) is often poorly reported, and it is unclear whether this element of research is conducted rigorously. This paper explores issues associated with developing attributes for DCEs and contrasts different qualitative approaches. The paper draws on eight studies, four developed attributes for measures, and four developed attributes for more ad hoc policy questions. Issues that have become apparent through these studies include the following: the theoretical framework for random utility theory and the need for attributes that are neither too close to the latent construct nor too intrinsic to people's personality; the need to think about attribute development as a two-stage process involving conceptual development followed by refinement of language to convey the intended meaning; and the difficulty in resolving tensions inherent in the reductiveness of condensing complex and nuanced qualitative findings into precise terms. The comparison of alternative qualitative approaches suggests that the nature of data collection will depend both on the characteristics of the question (its sensitivity, for example) and the availability of existing qualitative information. An iterative, constant comparative approach to analysis is recommended. Finally, the paper provides a series of recommendations for improving the reporting of this element of DCE studies., (Copyright © 2011 John Wiley & Sons, Ltd.)

Estimated time preference rates are extremely varied, with many rates being extremely high. Reviewing empirical studies without quantitative synthesis of their findings is largely unhelpful in determining how rates vary according to different factors. This study therefore explores the use of meta-regression techniques to combine available evidence to draw reliable conclusions about the factors influencing empirical time preference rates. Papers reporting empirically derived time preference rates related to health and health-care programmes were selected. Included were papers presenting all of: a mean time preference rate; information allowing derivation of standard errors; and one or more covariates. Appropriate data were derived from only eight of the 16 papers reporting empirical time preference rates. Meta-regression indicated that there were statistically significant relationships between mean time preference rates and: (a) delay period on a log scale; (b) whether the outcome question related to a gain or a loss. There were a number of limitations related to the use of meta-regression in this area, including difficulties in extracting appropriate data from the original studies, and the extent to which the original studies provide fully deliberated estimates of time preference.

To date, there has been little examination of the problems associated with conducting economic evaluation for interventions designed to contain antimicrobial resistance. There are two quite different types of intervention aimed at containing antimicrobial resistance: interventions which are designed to avoid the emergence of resistant organisms; and interventions that are designed to avoid the transmission of resistance organisms. Four aspects of economic evaluation where the ease of assessment might be expected to differ across evaluations for these different types of intervention are examined: problems associated with the identification of diffuse impacts, problems associated with comparing current and future impacts, problems associated with uncertainty, and problems associated with difficulties in measurement and valuation. The paper suggests that it may be much easier to conduct rigorous economic evaluations for interventions designed to avoid transmission of resistance, than for those intended to avoid emergence. Unfortunately, the transmission policies, which are likely to be the easiest to evaluate, are not likely to produce an optimal long-term outcome given the apparent irreversibility of much resistance and the potentially severe harms which could be imposed as a result. Given the desirability of avoiding a scenario where, in the evidence-based medicine culture, the most rigorously evaluated policies are followed even though they may be less important, there is the need to consider carefully what, and how, economic evaluation should be conducted in the area of antimicrobial resistance. It is suggested that research should focus on the use of modelling as a means of evaluating optimal policy responses and on trying to resolve some of the difficulties associated with measurement and valuation., (Copyright 2002 John Wiley & Sons, Ltd.)

This paper argues that increasing resistance to antimicrobials is an important social externality that has not been captured at the level of economic appraisal. The paper explicitly considers reasons why the externality of antimicrobial resistance has not generally been included as a cost in economic evaluations comparing management strategies for infectious diseases. Four reasons are considered: first, that the absolute cost of antimicrobial resistance is too small to be worth including; second, that there is an implicit discounting of the costs of antimicrobial resistance on the basis of time preference which makes the cost too small to be worth including; third, that there is an implicit discounting of the costs of antimicrobial resistance on the basis of uncertainty which makes the cost too small to be worth including; and fourth, that the costs are too difficult to measure. Although there does not appear to be methodological justification for excluding the costs of antimicrobial resistance, it seems likely that, because of the practical difficulties associated with measuring these costs, they will continue to be ignored. The paper concludes with a discussion of the applicability of standard policy responses used to deal with externalities in other areas of welfare economics.