A framework for extending the health-related quality adjusted life year by combining instruments.

Mulhern, B; Akanksha, A; Norman, R; Bahrampour, M; Jiang, P; Street, D; Viney, R

A framework for extending the health-related quality adjusted life year by combining instruments.

Mulhern, B Akanksha, A

Norman, R Bahrampour, M Jiang, P

Street, D Viney, R

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Publisher:: Springer Nature
Publication Type:: Journal Article
Citation:: Health Qual Life Outcomes, 2025, 23, (1), pp. 25
Issue Date:: 2025-03-24

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Field	Value	Language
dc.contributor.author	Mulhern, B
dc.contributor.author	Akanksha, A https://orcid.org/0000-0002-4899-7538
dc.contributor.author	Norman, R
dc.contributor.author	Bahrampour, M
dc.contributor.author	Jiang, P https://orcid.org/0009-0000-4173-3487
dc.contributor.author	Street, D
dc.contributor.author	Viney, R
dc.date.accessioned	2025-04-03T23:10:47Z
dc.date.available	2025-02-27
dc.date.available	2025-04-03T23:10:47Z
dc.date.issued	2025-03-24
dc.identifier.citation	Health Qual Life Outcomes, 2025, 23, (1), pp. 25
dc.identifier.issn	1477-7525
dc.identifier.issn	1477-7525
dc.identifier.uri	http://hdl.handle.net/10453/186575
dc.description.abstract	Current measurement systems focus mostly on health, and not on multiple constructs of quality of life outcomes (for example health and social outcomes) together. This means we don't capture all that is of value to those receiving treatments, and to society more broadly. Recent research has explored how to extend the quality adjusted life year (QALY) beyond a narrow focus on health-related quality of life (HRQoL) aiming to improve the allocation of scarce health and social care resources. Measures of different constructs, including the EuroQol-Health and Wellbeing (EQ-HWB), and different versions of the Adult Social Care Outcomes Toolkit (ASCOT) and ICEpop CAPability (ICECAP), have been developed. Another approach to extending the health focused QALY is to combine existing descriptive systems with different foci into a single instrument. This has the advantage of using available information and allowing trade-offs between the domains of the descriptive systems to be made explicit. The aim of this paper is to propose a framework to guide this approach and outline the methodological process for generating broader descriptive systems. The first section of the paper explains the framework for combining existing instruments and discusses advantages and disadvantages. Advantages include increasing measurement sensitivity to the wider combined quality of life (QoL) impacts of many interventions and using value sets encompassing preferences that are based on trade-offs across diverse constructs. This enables values informed by impacts on broader QoL with relevance across diverse populations, to be used. Disadvantages include theoretical limitations linked to the constructs of QoL included, and practical difficulties combining instruments. The second section of the paper describes the methodological process for generating combined descriptive systems. This includes how to identify which constructs of QoL could be included, and a description of the mixed methods work required to generate a descriptive system that is psychometrically valid, and appropriate for valuation. Combining constructs of QoL from existing instruments offers a promising way to extend the QALY that differs to developing instruments de novo. Future research can use the framework outlined to develop combined instruments and explore the feasibility and wider applicability of the approach, and the use of the instruments generated in resource allocation decision making.
dc.language	eng
dc.publisher	Springer Nature
dc.relation	http://purl.org/au-research/grants/arc/DP210102021
dc.relation.ispartof	Health Qual Life Outcomes
dc.relation.isbasedon	10.1186/s12955-025-02352-4
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1117 Public Health and Health Services
dc.subject.classification	Health Policy & Services
dc.subject.classification	4203 Health services and systems
dc.subject.classification	4206 Public health
dc.subject.mesh	Humans
dc.subject.mesh	Quality-Adjusted Life Years
dc.subject.mesh	Quality of Life
dc.subject.mesh	Surveys and Questionnaires
dc.subject.mesh	Psychometrics
dc.subject.mesh	Health Status
dc.subject.mesh	Humans
dc.subject.mesh	Quality-Adjusted Life Years
dc.subject.mesh	Quality of Life
dc.subject.mesh	Surveys and Questionnaires
dc.subject.mesh	Psychometrics
dc.subject.mesh	Health Status
dc.title	A framework for extending the health-related quality adjusted life year by combining instruments.
dc.type	Journal Article
utslib.citation.volume	23
utslib.location.activity	England
utslib.for	1117 Public Health and Health Services
pubs.organisational-group	University of Technology Sydney
pubs.organisational-group	University of Technology Sydney/Faculty of Health
pubs.organisational-group	University of Technology Sydney/UTS Groups
pubs.organisational-group	University of Technology Sydney/UTS Groups/Centre for Health Economics Research and Evaluation (CHERE)
utslib.copyright.status	open_access	*
dc.rights.license	This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0). To view a copy of this license, visit https://creativecommons.org/licenses/by-nc-nd/4.0/
dc.date.updated	2025-04-03T23:10:46Z
pubs.issue	1
pubs.publication-status	Published online
pubs.volume	23
utslib.citation.issue	1

Abstract:

Current measurement systems focus mostly on health, and not on multiple constructs of quality of life outcomes (for example health and social outcomes) together. This means we don't capture all that is of value to those receiving treatments, and to society more broadly. Recent research has explored how to extend the quality adjusted life year (QALY) beyond a narrow focus on health-related quality of life (HRQoL) aiming to improve the allocation of scarce health and social care resources. Measures of different constructs, including the EuroQol-Health and Wellbeing (EQ-HWB), and different versions of the Adult Social Care Outcomes Toolkit (ASCOT) and ICEpop CAPability (ICECAP), have been developed. Another approach to extending the health focused QALY is to combine existing descriptive systems with different foci into a single instrument. This has the advantage of using available information and allowing trade-offs between the domains of the descriptive systems to be made explicit. The aim of this paper is to propose a framework to guide this approach and outline the methodological process for generating broader descriptive systems. The first section of the paper explains the framework for combining existing instruments and discusses advantages and disadvantages. Advantages include increasing measurement sensitivity to the wider combined quality of life (QoL) impacts of many interventions and using value sets encompassing preferences that are based on trade-offs across diverse constructs. This enables values informed by impacts on broader QoL with relevance across diverse populations, to be used. Disadvantages include theoretical limitations linked to the constructs of QoL included, and practical difficulties combining instruments. The second section of the paper describes the methodological process for generating combined descriptive systems. This includes how to identify which constructs of QoL could be included, and a description of the mixed methods work required to generate a descriptive system that is psychometrically valid, and appropriate for valuation. Combining constructs of QoL from existing instruments offers a promising way to extend the QALY that differs to developing instruments de novo. Future research can use the framework outlined to develop combined instruments and explore the feasibility and wider applicability of the approach, and the use of the instruments generated in resource allocation decision making.

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http://hdl.handle.net/10453/186575