King's College London

Background: Effectiveness and cost-effectiveness are increasingly important considerations in determining which mental health services are funded. Questions have been raised concerning the validity of generic health status instruments used in economic evaluation for assessing mental health problems such as depression; measuring capability wellbeing offers a possible alternative. The aim of this study is to assess the validity of the ICECAP-A capability instrument for individuals with depression.

Methods: Hypotheses were developed using concept mapping. Validity tests and multivariable regression analysis were applied to data from a cross-sectional dataset to assess the performance of ICECAP-A in individuals who reported having a primary condition of depression. The ICECAP-A was collected alongside instruments used to measure: 1. depression using the depression scale of the Depression, Anxiety and Stress Scale (DASS-D of DASS-21);
2. mental health using the Kessler Psychological Distress Scale (K10); 3. generic health status using a common measure collected for use in economic evaluations, the five level version of EQ-5D (EQ-5D-5L).

Results: Hypothesised associations between the ICECAP-A (items and index scores) and depression constructs were
fully supported in statistical tests. In the multivariable analysis, instruments designed specifically to measure
depression and mental health explained a greater proportion of the variation in ICECAP-A than the EQ-5D-5L.

Conclusion: The ICECAP-A instrument appears to be suitable for assessing outcome in adults with depression for
resource allocation purposes. Further research is required on its responsiveness and use in economic evaluation.
Using a capability perspective when assessing cost-effectiveness could potentially re-orientate resource provision
across physical and mental health care services.