Incapacity Benefit: A Health or Labour Market Phenomenon?

The number of people claiming Incapacity Benefit has remained fairly constant in recent years at around 2.7 million (7% of the working age population), although the numbers have trebled since the 1970s when an earlier version of this benefit was available. In January 2006 the UK Government set the ambitious target of reducing the number of claimants by one million, or around 40% of the total, within the next decade. New initiatives will focus on increasing the number of people who remain in work and increasing the number leaving benefits and finding employment. This paper explores these two critical transitions using data from waves 5 to 13 of the British Household Panel Survey. We consider whether the moves onto and off benefit are driven by health status or whether labour market factors are also important. Our results show that while health, and in particular psychological health, is an important determinant of these transitions, other factors such as age, occupation and geographical location are also key explanatory factors. This suggests that a very broad range of policy measures will be required if the government is to meet its target

A review and meta analysis of health state utility values in breast cancer

Background and purpose: Health-related quality of life is an important issue in the treatment of breast cancer, and health-state utilities are essential for cost-utility analysis. This paper identifies and summarises published utilities for common health-related quality of life outcomes for breast cancer, considers the impact of variation in study designs used, and pools utilities for some breast cancer health states. Data sources and study selection: 13 databases were searched using key words relating to breast cancer and utility measurement. Articles were included if specified empirical methods for deriving utility values were used and details of the method, including number of respondents, were given. Articles were excluded if values were based on expert opinion or were not unique. Data extraction and synthesis: The authors identified 49 articles which met their inclusion criteria, providing 476 unique utilities for breast cancer health states. Where possible, mean utility estimates were pooled using ordinary least squares with utilities clustered within study group and weighted by both number of respondents and inverse of the variance of each utility. Regressions included controls for disease state, utility assessment method and other features of study design. Results: Utility values found in the review are summarised for six categories: 1) screening related states, 2) preventative states, 3) adverse events in breast cancer and its treatment, 4) non-specific breast cancer, 5) metastatic breast cancer states and 6) early breast cancer states. Pooled utility values for the latter two categories are estimated, showing base state utility values of between 0.668 and 0.782 for early breast cancer and 0.721 and 0.806 metastatic breast cancer depending upon which model is used. Utilities were found to vary significantly by valuation method, and who conducted the valuation. Conclusions: A large number of utility values for breast cancer are available in the literature; the states that these refer to are often complex, making pooling of values problematic

A systematic review of the validity and responsiveness of EQ-5D and SF-6D for depression and anxiety

Background: Generic preference based measures (PBM) such as the SF-6D and EQ-5D are increasingly used to inform health care resource allocation decisions. They aim to be generic in the sense of being applicable to all physical and mental health conditions. However, their applicability has not been demonstrated for all mental health conditions. Aims: To assess the construct validity and responsiveness of EQ-5D and SF-6D measures in depression and anxiety. Method: A systematic review of the literature was undertaken. Eleven databases were searched in December 2010 and reference lists scrutinised to identify relevant studies. Studies were appraised and data extracted. A narrative synthesis was performed of the evidence on construct validity including known groups validity (detecting a difference in PBM scores between different groups such as different levels of severity of depression), convergent validity (strength of association between generic PBM and other outcome measures) and responsiveness (the ability to detect relevant health changes in health status and the absence of change where there is none). Results: 26 studies were identified that provided data on the validity and/or responsiveness of the EQ-5D and SF-6D. Both measures demonstrate good construct validity and responsiveness for depression. One study, however, suggests EQ-5D may lack responsiveness in the elderly. These measures are more highly correlated with depression scales in patients with anxiety than they are clinical anxiety scales suggesting known group validity in patients with anxiety may be driven by aspects of depression within anxiety disorder and the presence of co-morbid depression. Direct comparisons between the measures find that the EQ-5D gives lower utility levels for severe depression hence greater health improvement for this group and SF-6D shows more sensitivity to mild depression and performs better in terms of ES and SRM. The comparison between EQ-5D and SF-6D is similar to that found in other conditions. Conclusion: The evidence base supports the use of EQ-5D and SF-6D in patients with depression and anxiety. More work is needed on the true utility level for severe depression

An empirical comparison of well-being measures used in the UK

A number of different, yet related, measures of subjective well-being (SWB) and health are used across government departments. Under its Measuring National Well-being Programme, the Office of National Statistics (ONS) has adopted the use of the short Warwick Edinburgh Mental Well-being Scale (SWEMWBS) and the General Health Quest ionnaire (GHQ-12) which is a mental health screening measure, as well as four summary subjective (personal) well-being questions which ask about life satisfaction, happiness and anxiety yesterday, and worthwhileness (the ONS-4). I n addition to the measures used within the ONS framework, the National Institute for Health and Care Excellence (NICE) currently preferthe EQ-5D, a measure of health-related quality of life (HRQoL), in the assessment of medical technologies and public health interventions, while social care guidance includes measures of capability and need, the Investigating Choice Experiments Capability Measures for Older people/Adults(ICECAP-A and ICECAP-O) and the Adult Social Care Outcomes Toolkit (ASCOT). There is limited evidence on how these measures relate to each other, which causes difficulty in the comparison of results across datasets and evaluations containing different measures as well as for informing decisions across sectors. Given that these measures are used to inform policy making throughout Government, it is important to better understand how these measures compare. The Department of Health has asked the Policy Research Unit in Economic Evaluation of Health and Care Interventions (EEPRU) to undertake a conceptual and empirical comparison of these six commonly used measures of health and well-being: SWEMWBS, GHQ-12, ONS-4, ICECAP-A, ASCOT and EQ-5D. This report summarises psychometric analysis including factor analysis which sought to compare the ONS- 4, the SWEMWBS/WEMWBS, the GHQ-12, the ICECAP-A or ICECAP- O, ASCOT, the EQ-5D and the SF-6D. The report also takes into consideration additional measures of SWB found within the datasets to shed further light on these comparisons and the concepts behind the measures

A conceptual comparison of well-being measures used in the UK

There is significantpolitical interest in the UK in measuring subjective well- being (SWB) and the possibility of incorporating such measures into policy, including health policy. A number of different, yet related, measures of well-being and health are used across government departments. This includes four summary subjective (personal) well -being questions which ask about life satisfaction, happiness yesterday, anxiety yesterday and worthwhileness adopted by the Office of National Statistics (ONS) under its Measuring National Well-being Programme(referred to here as the ONS-4). They have also adopted the use of the short Warwick Edinburgh Mental Well-being Scale (S- WEMWBS) and the General Health Questionnaire (GHQ-12) which is a mental health screening measure that has been used in well-being measurement. In addition to the measures used within the ONS framework, the National Institute for Health and Care Excellence (NICE) currently rely upon the EQ-5D, a measure of health- related quality of life (HRQoL), in the assessment of medical technologies and public health interventions while social care guidance includes measures of capability and need, ICECAP-A and Adult Social Care Outcomes Toolki

Experience-based utility and own health state valuation: why do it and how to do it

In the estimation of population value sets for measures such as the EQ-5D, there is increasing interest in asking respondents to value their own health state, sometimes referred to as “experience-based utility values”, rather than hypothetical health states. Evidence shows that these experience-based utility values differ to hypothetical health state values. This may be attributed to many reasons. This paper first critically examines: why this difference is important, whether own visual analogue scale (VAS) or time trade-off (TTO) really measure experience-based utility values, the biases from current methods of collecting experience-based utility data, and the modelling of the data. Second, the paper reviews some of the normative arguments for and against using own health state valuation. Finally, the paper also examines other ways own health state values can be taken into account, such as including the use of informed general population preferences that may better take into account experience-based values

Systematic review of the effect of a one-day versus seven-day recall duration on Patient Reported Outcome Measures (PROMs)

Background There is ongoing uncertainty around the most suitable recall period for patient-reported outcome measures (PROMs). Method This systematic review integrates quantitative and qualitative literature across health, economics, and psychology to explore the effect of a one-day (or ‘24-h’) versus seven-day (or ‘one week’) recall period. The following databases were searched from database inception to 30 November 2021: MEDLINE, EMBASE, PsycINFO, Web of Science, EconLit, CINAHL Complete, Cochrane Library, and Sociological Abstracts. Studies were included that compared a one-day (or ‘24-h’) versus seven-day (or weekly) recall period condition on patient-reported scores for PROM and Health-Related Quality-of-Life (HRQoL) instrument scores in adult populations (aged 18 and above) or combined paediatric and adult populations with a majority of respondents aged over 18 years. Studies were excluded if they assessed health behaviours only, used ecological momentary assessment to derive an index of daily recall, or incorporated clinician reports of patient symptoms. We extracted results relevant to six domains with generic health relevance: physical functioning, pain, cognition, psychosocial wellbeing, sleep-related symptoms and aggregated disease-specific signs and symptoms. Quantitative studies compared weekly recall scores with the mean or maximum score over the last seven days or with the same-day recall score. Results Overall, across the 24 quantitative studies identified, 158 unique results were identified. Symptoms tended to be reported as more severe and HRQoL lower when assessed with a weekly recall than a one-day recall. A narrative synthesis of 33 qualitative studies integrated patient perspectives on the suitability of a one-day versus seven-day recall period for assessing health state or quality of life. Participants had mixed preferences, some noted the accuracy of recall for the one-day period but others preferred the seven-day recall for conditions characterised by high symptom variability, or where PROMs concepts required integration of infrequent experiences or functioning over time. Conclusion This review identified a clear trend toward higher symptom scores and worse quality of life being reported for a seven-day compared to a one-day recall. The review also identified anomalies in this pattern for some wellbeing items and a need for further research on positively framed items. A better understanding of the impact of using different recall periods within PROMs and HRQoL instruments will help contextualise future comparisons between instruments

Systematic review of the evidence on housing interventions for ‘housing-vulnerable’ adults and its relationship to wellbeing

Access to safe, good quality affordable housing is essential to wellbeing and housing related factors can have an important influence on neighbourliness and sense of community belonging. A recent scoping review on housing and wellbeing identified a lack of review-level evidence around the impact of housing interventions on wellbeing of people who are vulnerable to discrimination or exclusion in relation to housing (Preston et al., 2016). This systematic review was commissioned to address that gap. We synthesise and consider the quality of evidence on how housing interventions can contribute to improving the lives of adults who are vulnerable in relation to the security of their housing tenure (‘housing-vulnerable’ adults)

Experience-based utility and own health state valuation: why do it and how to do it

In the estimation of population value sets for measures such as the EQ-5D, there is increasing interest in asking respondents to value their own health state, sometimes referred to as “experience-based utility values”, rather than hypothetical health states. Evidence shows that these experience-based utility values differ to hypothetical health state values. This may be attributed to many reasons. This paper first critically examines: why this difference is important, whether own visual analogue scale (VAS) or time trade-off (TTO) really measure experience-based utility values, the biases from current methods of collecting experience-based utility data, and the modelling of the data. Second, the paper reviews some of the normative arguments for and against using own health state valuation. Finally, the paper also examines other ways own health state values can be taken into account, such as including the use of informed general population preferences that may better take into account experience-based values

Rethinking ADHD intervention trials: feasibility testing of two treatments and a methodology

Attention deficit hyperactivity disorder (ADHD) is a lifelong condition associated with considerable costs. The long-term effectiveness and acceptability of treatments to improve outcomes remains in doubt. Long-term trials are needed comparing interventions with standard care and each other. The Sheffield Treatments for ADHD Research (STAR) project used the Trials within Cohorts (TwiCs) approach. A cohort of children with ADHD was recruited and outcomes collected from carers and teachers. A random selection was offered treatment by homoeopaths (hom) or nutritional therapists (NT). Their outcomes (Conners Global ADHD Index) were compared with those not offered interventions. The feasibility of the methods and interventions was assessed. The TwiCs approach was feasible with modifications. 144 participants were recruited to the cohort, 83 offered treatment, 72 accepted, and 50 attended 1+ appointments. Results according to carers assessments at 6 months were as follows: t = 1.08, p = .28 (− 1.48, 4.81) SMD .425 (hom); t = 1.71, p = .09 (− .347, 5.89), SMD = .388 (NT). Teachers’ responses were too few and unstable. No serious treatment adverse events occurred. Conclusion: the STAR project demonstrated the feasibility of the TwiCs approach for testing interventions for children with ADHD