In health economics and quality of life research, conventional metrics often barely focus on health status or disease burden. Nonetheless, human well-being goes beyond the physical body into domains of autonomy, personal growth, and social connection. The ICEpop CAPability measure for Adults (ICECAP-A) represents a precise and innovative endeavour to summarize the wider well-being perspective by quantifying what people are able to do and be, providing an approach based on capabilities.[1, 2]
Unlike the metrics for symptoms or medical interventions, the ICECAP-A instrument is developed to evaluate the individuals’ capacity to live the life they want. It moves the focus of assessments from health outcomes to life capabilities, depicting the belief that authentic quality of life goes beyond just being disease-free. This methodology facilitates researchers, policymakers, and care providers to better comprehend and cater to the wide range of factors that impact human well-being.[1, 2]
Developed in 2012, the ICECAP-A instrument measures five characteristics, viz. stability (feeling of security), attachment (having support, love, and friendship), autonomy (independence), achievement (growth and progress in life), and enjoyment (experiencing joy and pleasure). This tool has four response levels and has been extensively translated. Each domain is scored through self-report, enabling individuals to contemplate how well they can perform in these aspects of life. A set of values enable its application in economic assessments through metrics including Years of Full Capability (YFC) or Sufficient Capability (YSC), supporting more impartial, capability-based decision-making. The significance of this instrument lies in its reliance on potential and opportunity, rather than only performance or achievement.[1, 2, 3]
Developed with the help of qualitative interviews and thorough psychometric testing, ICECAP-A is especially important for those interventions that may or may not improve health, but substantially improve an individual’s capability to live well. For example, social care services, palliative care, mental health support, and community-based interventions usually seek to increase an individual’s sense of control, connection, and pride; outcomes often overlooked by conventional clinical measurements. The ICECAP-A tool facilitates researchers to encapsulate the value of these interventions more effusively.[1-4]
Growing interest in the capability method in health economics underscores its wider assessing scope, demonstrating the impact of well-being measurements beyond outcomes that represent health-related functioning. While several regulatory bodies like NICE (UK) [5] and Zorginstituut Nederland (The Netherlands) [6] recognize the value of capability outcomes in economic assessments; these measures are still new and necessitate continuous validation and evidence review.[1]
The preference-based approach of ICECAP-A facilitates economic evaluations, such as cost-utility analyses, by allotting a value to each of the five states of capability. This can further help decision-makers compare the efficacy of different services in aspects that go beyond Quality-Adjusted Life Years (QALYs) to signify what truly matters to individuals in their daily lives. [1, 2]
ICECAP-A is being increasingly distinguished in public health and policy domains for providing a refined, more person-centred basis for assessing care outcomes. By focusing on human capabilities, the ICECAP-A instrument encourages researchers to approach health and social care differently. It challenges healthcare systems to give precedence to empowerment, opportunity, and contentment, rather than just symptom mitigation or disease control; thereby aligning with modern perspectives of well-being and fair, person-centred care. As the need for policies depicting the real lives and values of individuals grows, the ICECAP-A metric will be a robust tool for directing more empathetic, inclusive, and crucial decision-making.
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References
- Al-Janabi H, Flynn TN, Coast J. Development of a self-report measure of capability wellbeing for adults: the ICECAP-A. Qual Life Res. 2012 Feb;21(1):167-76.
- Afentou N, Kinghorn P. A Systematic Review of the Feasibility and Psychometric Properties of the ICEpop CAPability Measure for Adults and Its Use So Far in Economic Evaluation. Value Health. 2020; 23(4):515-526.
- Rohrbach PJ, Dingemans AE, Groothuis-Oudshoorn CGM, et al. The ICEpop Capability Measure for Adults Instrument for Capabilities: Development of a Tariff for the Dutch General Population. Value Health. 2022; 25(1):125–132.
- Rencz F, Mitev AZ, Jenei B, Brodszky V. Measurement properties of the ICECAP-A capability well-being instrument among dermatological patients. Qual Life Res. 2022 Mar;31(3):903-915.
- NICE (UK). The social care guidance manual. (Last updated in July 2016). Available online at: https://www.nice.org.uk/process/pmg10/resources/the-social-care-guidance-manual-pdf-72286648234693
- Zorginstituut Nederland. Guideline for economic evaluations in healthcare. 2024. Available online at: https://english.zorginstituutnederland.nl/about-us/publications/reports/2024/01/16/guideline-for-economic-evaluations-in-healthcare