The Relative Impacts of Disease on Health Status and Capability Wellbeing: A Multi-Country Study

Mitchell, Paul Mark, Hareth Al-Janabi, Jeff Richardson, Angelo Iezzi, and Joanna Coast. "The Relative Impacts of Disease on Health Status and Capability Wellbeing: A Multi-Country Study." PLoS ONE 10 (2015): e0143590. doi: 10.1371/journal.pone.0143590


Evaluations of the impact of interventions for resource allocation purposes commonly focus
on health status. There is, however, also concern about broader impacts on wellbeing and,
increasingly, on a person’s capability. This study aims to compare the impact on health status
and capability of seven major health conditions, and highlight differences in treatment
priorities when outcomes are measured by capability as opposed to health status.


The study was a cross-sectional four country survey (n = 6650) of eight population groups:
seven disease groups with: arthritis, asthma, cancer, depression, diabetes, hearing loss,
and heart disease and one health population ‘comparator’ group. Two simple self-complete
questionnaires were used to measure health status (EQ-5D-5L) and capability (ICECAP-A).
Individuals were classified by illness severity using condition-specific questionnaires. Effect
sizes were used to estimate: (i) the difference in health status and capability for those with
conditions, relative to a healthy population; and (ii) the impact of the severity of the condition
on health status and capability within each disease group.


5248 individuals were included in the analysis. Individuals with depression have the greatest
mean reduction in both health (effect size, 1.26) and capability (1.22) compared to the
healthy population. The effect sizes for capability for depression are much greater than for
all other conditions, which is not the case for health. For example, the arthritis group effect
size for health (1.24) is also high and similar to that of depression, whereas for the same
arthritis group, the effect size for capability is much lower than that for depression (0.55). In
terms of severity within disease groups, individuals categorised as ‘mild’ have similar capability
levels to the healthy population (effect sizes

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