Innovations in cost-effectiveness analysis that advance equity can expand its use in health policy

• Published in: BMJ global health 2022-02, Vol.7 (2), p.e008140
• Main Authors: Avanceña, Anton L.V., Prosser, Lisa A
• Format: Article
• Language: English
• Subjects: Commentary; Cost analysis; Cost control; Cost-Benefit Analysis; Decision making; Disability; Efficiency; Health care expenditures; Health care policy; Health disparities; Health economics; Health Equity; health policies and all other topics; Health Policy; Humans; Intervention; Medicare; Public health; Quality of life; Socioeconomic factors
• ISSN: 2059-7908; 2059-7908
• DOI: 10.1136/bmjgh-2021-008140

CEA was originally developed to maximise efficiency in healthcare; other equally important goals such as achieving health equity or the elimination of unjust health disparities are excluded. [...]while an intervention might be considered cost-effective, its costs and benefits may be differentially borne by certain groups in society, and a decision-maker would be unable to identify these distributional consequences in a conventional CEA.6 Conventional CEA also does not provide any information about the trade-offs between efficiency and equity. Methods such as distributional CEA, a type of equity-informative CEA, can quantify the distribution of an intervention’s costs and health benefits across the population and evaluate equity and efficiency trade-offs.6 Another type of equity-informative CEA called extended CEA considers the financial risk protection afforded by the adoption of a publicly financed health intervention, in addition to the distribution of its health gains and costs across population groups.12 Extended CEA has been used to evaluate health policies and interventions such as vaccination programmes, mental health treatment and taxes on tobacco and sugar-sweetened beverages. [...]equity-informative CEAs require more data than conventional CEA since population-specific inputs are needed to estimate the distribution of costs and health effects of an intervention. [...]for distributional CEA in particular, new measures such as population-level estimates of the inequality aversion parameter are needed to determine the preferred health distribution;6 these parameters, however, have not been measured outside of selected high-income settings, as is the case for equity weights.10 These challenges are surmountable, and several changes are in place that may increase the application of equity-informative CEAs.