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Conceptualising ‘Benefits Beyond Health’ in the Context of the Quality-Adjusted Life-Year: A Critical Interpretive Synthesis

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Abstract

There is growing interest in extending the evaluative space of the quality-adjusted life-year framework beyond health. Using a critical interpretive synthesis approach, the objective was to review peer-reviewed literature that has discussed non-health outcomes within the context of quality-adjusted life-years and synthesise information into a thematic framework. Papers were identified through searches conducted in Web of Science, using forward citation searching. A critical interpretive synthesis allows for the development of interpretations (synthetic constructs) that go beyond those offered in the original sources. The final output of a critical interpretive synthesis is the synthesising argument, which integrates evidence from across studies into a coherent thematic framework. A concept map was developed to show the relationships between different types of non-health benefits. The critical interpretive synthesis was based on 99 papers. The thematic framework was constructed around four themes: (1) benefits affecting well-being (subjective well-being, psychological well-being, capability and empowerment); (2) benefits derived from the process of healthcare delivery; (3) benefits beyond the recipient of care (spillover effects, externalities, option value and distributional benefits); and (4) benefits beyond the healthcare sector. There is a wealth of research concerning non-health benefits and the evaluative space of the quality-adjusted life-year. Further dialogue and debate are necessary to address conceptual and normative challenges, to explore the societal willingness to sacrifice health for benefits beyond health and to consider the equity implications of different courses of action.

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Authors and Affiliations

  1. Faculty of Health, Deakin University, Burwood, VIC, Australia

    Lidia Engel

  2. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada

    Lidia Engel & David G. T. Whitehurst

  3. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    Stirling Bryan

  4. Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada

    Stirling Bryan & David G. T. Whitehurst

Authors
  1. Lidia Engel
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  2. Stirling Bryan
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  3. David G. T. Whitehurst
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Correspondence to Lidia Engel.

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This work has been conducted without financial support.

Conflicts of Interest

LE, SB and DGTW are members of the EuroQol Group Association. The authors report no further conflicts of interest.

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Availability of Data and Material

Source data for the synthesis presented in this paper were obtained from the included studies, which are cited in the reference list.

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Author Contributions

All authors contributed to the study conception and design. LE performed the literature searches, undertook the screening, extracted the data and developed initial constructs. The thematic framework was developed through discussion between all authors. LE wrote the first draft of the manuscript and undertook subsequent revisions; SB and DGTW provided review and critical revision. All authors read and approved the final version prior to submission.

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Engel, L., Bryan, S. & Whitehurst, D.G.T. Conceptualising ‘Benefits Beyond Health’ in the Context of the Quality-Adjusted Life-Year: A Critical Interpretive Synthesis. PharmacoEconomics 39, 1383–1395 (2021). https://doi.org/10.1007/s40273-021-01074-x

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