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Title [sv]
Goda år - ett nytt mått för utvärdering av välfärdsinsatser
Title [en]
Capability Adjusted Life years (CALYs) - a novel measure for evaluating welfare interventions
Abstract [sv]
Behovet av utvärdering och prioritering av välfärsinsatser har ökat, och bör vägledas av både effektivitets- och rättvisekriterier. I hälso- och sjukvård har den sofistikerade ?kronor per vunnet kvalitetsjusterad levnadsår? utvecklats och kommit att få stor betydelse. Kommunerna har inget motsvarande, utan de använder enkla metoder. Principen är enkel: en insats kostar men antas leda till besparingar. Att rehabilitera missbrukare kostar men antas leda till mindre kriminalitet (=besparing) och mindre bidrag (=besparing). Om besparingarna är större än kostnaderna är rehabiliteringen ?lönsam?. Men vilken slutsats följer om rehabiliteringen är framgångsrik (=mindre missbruk) men inte leder till nettobesparingar? Exemplet visar att ekonomisk analys av offentlig verksamhet utan ett mått på individers livskvalitet är dömd att ge svårtolkade eller rent av vilseledande resultat.  Syftet med vår studie är därför att utveckla ett mått på livskvalitet som vi kallar ?goda år?. Goda år kan användas för att beräkna om insatser är kostnadseffektiva, men också för att gradera sociala problem. Ju färre goda år en grupp kan räkna med, ju alvarligare är problemet.Vi bygger vidare på en offentlig utredning (SOU 2015:56) som föreslog att livskvalitet skulle kunna mätas i termer av handlingsfrihet. Handlingsfrihet ger goda år, medan brist på handlingsfrihet ger svåra år. För att välja ut de ?handlingsfriheter? som är viktigast för livskvalitet i dagens Sverige tänker vi använda livserfarna och kloka personer med olika bakgrund.  Vi genomför också en stor enkätstudie i ett representativt urval. De statistiska metoder som utvecklats för att skatta kvalitetsjusterade levnadsår kan också användas för att skatta ?goda år?. En bra metod för att göra en skala för att mäta ?goda år? är WHO:s ?parvis jämförelse?, där två hypotetiska personer beskrivs i samma dimensioner men med olika nivåer av handlingsfrihet, och där respondenten bara har att bedöma vilken av de två som har en högre livskvalitet.
Abstract [en]
There is increasing need for the evaluation and prioritisation of welfare policies, guided both by effectiveness and equity considerations. In health care and public health, the sophisticated cost per QALY gained measure is widely used. Other parts of the welfare state have, in theory, to rely on cost-benefit analysis - CBA. However, CBA is rarely used. Rather, a very simple cost-saving analysis has become increasingly more popular, particularly among municipalities. The main weakness of cost-saving analysis is the lack of independent valuation of the quality of life consequences. It introduces a bias in favour of actions that ?save? resources, so that actions that bring about better quality of life but consume resources will consequently be given low priority.To provide methods for more accurate evaluation, we intend to develop and test a measure called ?capability-adjusted life years? or CALYs. CALYs can be used to estimate cost-effectiveness, but also to rank social problems. The fewer the lifetime CALYs a certain group can expect, the more severe the problem.A recent Swedish public investigation suggested that quality of life could be measured in terms of capabilities, and went on to suggest a list of capabilities relevant to Sweden. To have capabilities equates to good years, to lack capabilities means bad years. Selection of the most relevant capabilities for our model will be placed in the hands of ?fair minded people?, i.e. wise people from different backgrounds. We plan to conduct a population survey on a representative sample. Statistical methods developed to estimate QALYs and DALYs are also appropriate for CALYs. An interval scale for capability weights will be established through ?pairwise comparisons?, a method used by WHO in the Global Burden of Disease Study. Basically, two hypothetical persons are described as having the same capability dimensions but on two different levels. Respondents must judge who has the better quality of life.
Publications (1 of 1) Show all publications
Meili, K. W., Månsdotter, A., Richter Sundberg, L., Hjelte, J. & Lindholm, L. (2022). An initiative to develop capability-adjusted life years in Sweden (CALY-SWE): Selecting capabilities with a Delphi panel and developing the questionnaire. PLOS ONE, 17(2), Article ID e0263231.
Open this publication in new window or tab >>An initiative to develop capability-adjusted life years in Sweden (CALY-SWE): Selecting capabilities with a Delphi panel and developing the questionnaire
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2022 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 2, article id e0263231Article in journal (Refereed) Published
Abstract [en]

Introduction: 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.

Material and methods: 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.

Results: 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.

Conclusion: We developed a capability-based model for cost effectiveness economic evaluations of broader social consequences, specific to the Swedish context.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2022
National Category
Health Sciences
Research subject
health services research; Public health
Identifiers
urn:nbn:se:umu:diva-192308 (URN)10.1371/journal.pone.0263231 (DOI)000798968600010 ()35134053 (PubMedID)2-s2.0-85124191312 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00143
Available from: 2022-02-08 Created: 2022-02-08 Last updated: 2024-01-27Bibliographically approved
Principal InvestigatorLindholm, Lars
Coordinating organisation
Umeå University
Funder
Period
2018-12-01 - 2021-11-30
National Category
Social Sciences Interdisciplinary
Identifiers
DiVA, id: project:629Project, id: 2018-01550_Forte

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