Constraints, Capacity and Capability: An Application of Mathematical Optimisation Methods

Research output: Chapter in Book/Report/Conference proceedingConference contributionpeer-review


Purpose: The National Bloodspot Screening programme (NBSP) requires parental informed
consent before testing newborns for inherited diseases. This nation-wide information provision
process comes from a constrained supply of midwives. Capability-based outcome measures have
gained attention as a way of evaluating healthcare programmes. This study illustrates how
optimisation methods can take account of capacity constraints while using measures of capability
to value information provision in the NBSP.
Method(s): Linear programming, a mathematical optimisation technique, was used to identify
the optimal parental information approach to as part of the NBSP informed consent process.
Responses from a discrete choice experiment (n = 702) comprising 4 attributes (3 process and
capability to make an informed decision) were used to populate an objective function that aimed
to maximise capability to make an informed decision. The optimal solution was constrained so
that monetary and time costs of information provision can be no greater than those of current
Result(s): The mathematical optimisation results suggested that the types of information given to
parents should differ from current practice. Information should be provided during a woman’s
pregnancy in an individual discussion supported by a leaflet, rather than after the baby is born, as
in the current programme. Adopting this approach could increase parents’ capability to make an
informed decision by 145% whilst saving the NHS £50,000 per year and 5097 hours of midwife
Conclusion(s): Optimisation techniques, when used alongside cost-effectiveness analysis, have
the potential to enhance medical decision making, specifically, when health system capacity
constraints are important
Original languageEnglish
Title of host publicationMedical Decision Making
Publication statusPublished - 1 Sept 2016


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