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HEAM seminar — Wednesday October 4, 3:30 – 5:00pm, CRL B119

Mia Kibel & Meredith Vanstone: Reconciling ethical and economic conceptions of value in health policy using the capabilities approach: A qualitative investigation of Non-Invasive Prenatal Testing (NIPT)

Sep 20, 2017

Health policy decisions about new technologies must consider the economic impact of the technology alongside an evaluation of clinical efficacy and ethical implications. This type of holistic evaluation is challenging because each of these assessments are built on different and potentially contradictory assumptions of the technology’s value. To explore this challenge, we use the case of Non-Invasive Prenatal Testing (NIPT) to demonstrate the utility of the capabilities approach to reconcile economic and ethical framings of “value”.  NIPT was chosen as an exemplar of the tension between economic and ethical evaluations because typical economic evaluations of this technology assess NIPT’s ability deliver on goals (i.e. preventing birth of children with disabilities) that the ethical analysis suggests it should not have.

The capabilities approach is an economic framework which bases wellbeing assessments on a person’s abilities, rather than their expressed preferences. It is linked to extra-welfarist approaches in health economic assessment, and differs from welfarism in recognizing that measuring only expressed preferences means missing potentially important values and constraints to action, which may be key to the evaluation of health technology. We explored the potential of the capabilities approach to develop a conception of value for NIPT that is relevant to ethical and economic analyses. Beginning with Nussbaum’s capability framework, we conducted a directed qualitative content analysis of interview data collected from 27 Canadian women with personal experience of this technology. From this data, we identified particular capabilities relating to the options, choices or states that NIPT offers women the opportunity to achieve. This expansion of more and different choices in the prenatal care pathway was valued by women, but is not reflected in current economic assessments of NIPT. These findings provide the first step to operationalizing a capabilities approach that will contribute to economic evaluations of morally complex technologies that are consistent with patient preferences and ethical concerns.