Abstract
Capability-adjusted life years Sweden (CALY-SWE) are a new Swedish questionnaire-based measure for quality of life based on the capability approach. CALY-SWE are targeted towards use in cost-effectiveness evaluations of social welfare consequences. Here, we first motivate the measure both from a theoretical and from a Swedish policy-making perspective. Then, we outline the core principles of the measure, namely the relation to the capability approach, embedded equity considerations inspired by the fair-innings approach, and the bases for which capabilities should be considered. The aims were to 1) the most vital capabilities for individuals in Sweden, 2) to define a sufficient level of each identified capability to lead a flourishing life, and to 3) develop a complete questionnaire for the measurement of the identified capabilities. For the selection of capabilities, we used a Delphi process with Swedish civil society representants. To inform the questionnaire development, we conducted a web survey in three versions, with each Swedish 500 participants, to assess the distribution of capabilities that resulted from the Delphi process in the Swedish population. Each version was formulated with different strictness so that less strict wordings of a capability level would apply to a larger share of participants. All versions also included questions on inequality aversion regarding financial, educational, and health capabilities. The Delphi process resulted in the following six capabilities: Financial situation & housing, health, social relations, occupations, security, and political & civil rights. We formulated the final phrasing for the questionnaire based on normative reasons and the distribution of capabilities in the population while taking into account inequality aversion. We developed a capability-based model for cost effectiveness economic evaluations of broader social consequences, specific to the Swedish context.
Highlights
Capability-adjusted life years Sweden (CALY-SWE) are a new Swedish questionnairebased measure for quality of life based on the capability approach
The aim of this paper is to describe a Swedish initiative to develop a new outcome measure for public health and social interventions, capability-adjusted life years (CALY-SWE), for use in economic evaluations [1]
The measure is based on Sen’s capability approach [2, 3], and the quality-adjusted life years (QALYs) methodology that is frequently used for economic evaluations in healthcare [4]
Summary
Capability-adjusted life years Sweden (CALY-SWE) are a new Swedish questionnairebased measure for quality of life based on the capability approach. The aim of this paper is to describe a Swedish initiative to develop a new outcome measure for public health and social interventions, capability-adjusted life years (CALY-SWE), for use in economic evaluations [1]. The measure is based on Sen’s capability approach [2, 3], and the quality-adjusted life years (QALYs) methodology that is frequently used for economic evaluations in healthcare [4]. The background section motivates CALY-SWE from a Swedish policy perspective and outlines the historical development in health economics from utilitarianism and cost-benefit analysis to extra-welfarism and QALYs, and how this historic context relates to CALYs. the principles of our measure are described, followed by two investigations. We aimed to formulate questions that measure each capability on three levels, where the highest level corresponds to having the opportunity of living a flourishing life
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