Abstract
Distributional cost-effectiveness analysis (DCEA) is a framework for incorporating health inequality concerns into the economic evaluation of health sector interventions. In this tutorial, we describe the technical details of how to conduct DCEA, using an illustrative example comparing alternative ways of implementing the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP). The 2 key stages in DCEA are 1) modeling social distributions of health associated with different interventions, and 2) evaluating social distributions of health with respect to the dual objectives of improving total population health and reducing unfair health inequality. As well as describing the technical methods used, we also identify the data requirements and the social value judgments that have to be made. Finally, we demonstrate the use of sensitivity analyses to explore the impacts of alternative modeling assumptions and social value judgments.
Highlights
When designing and prioritizing interventions, health care decision makers often have concerns about reducing unfair health inequality as well as improving total population health
distributional cost-effectiveness analysis (DCEA) is a framework for incorporating health inequality concerns into the cost-effectiveness analysis of health care interventions
DCEA does not prescribe in advance any particular set of social value judgments about health inequality
Summary
When designing and prioritizing interventions, health care decision makers often have concerns about reducing unfair health inequality as well as improving total population health. These standard methods of CEA do not provide decision makers with information about the health inequality impacts of the interventions evaluated, or the nature and size of any tradeoffs between improving total population health and reducing unfair health inequality. To address these shortcomings, we have developed a framework for incorporating health inequality impacts into CEA, which we call distributional cost-effectiveness analysis (DCEA).[1] DCEA is suitable for health sector decisions concerning the design and prioritization of any type of health care intervention with an explicit health inequality reduction objective—potentially including treatments as well as preventive health care such as programs of health promotion, screening, vaccination, case finding, primary and secondary prevention of chronic disease, and so on. This variation in uptake can be modeled to estimate its impact on mortality and morbidity for the different socioeconomic subgroups in the population, and to describe the impact of the screening program on both the average level of health and the social distribution of health in the population
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