Outcomes measurement for economic evaluation

Abstract

Benefits or outcomes are used in economic evaluation to assess welfare maximization or health gain, depending on theoretical view - whether its a welfarist or extra-welfarist perspective. On the other hand, the measurement of health outcomes are usually related to clinical symptoms, physical functioning, and quality of life. In the Mental Health field, using exclusively clinical outcomes is not appropriate to capture all benefits obtained from treatments. Social and psychological dimensions are also crucial components to evaluate mental health gains. In economic evaluation, the choice of outcome should be based on the relevance to the patient's health and quality of life. Therefore, several challenges exist in defining the best mental health outcome in economic evaluation. In an extra-welfarist approach, outcomes in economic evaluation are classified into two main groups: one not based on client preferences (so-called measures), and a second based on client preferences (so-called values). Methods for assessing measures are scales based on specific and nonspecific disease symptoms. Methods for assessing outcome values are standard gamble, time trade-off, rating scales, and ratio scales. Only standard gamble assesses utility because it involves preferences based on uncertainty. The person trade-off method and multiattribute tools use expert panels and indirect methods, respectively, to assess outcome values. The capability approach has recently emerged as a new alternative to welfarist approach, focusing in broader measurement of outcomes related to individual's capability and quality of life. This concept was operationalized into a multidimensional instrument for the Mental Health field: ICECAP-MH. In the welfarist approach, outcomes are expressed in monetary units and assessed mainly by contingent valuation (CV; willingness-to- pay method) and discrete experiment choice. This chapter describes these methods and discusses their advantages and disadvantages for economic evaluation in the Mental Health field.