Aggregate distributional cost-effectiveness analysis of health technologies

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Health inequalities can be partially addressed through the range of treatments funded by health systems. However, whilst health technology assessment agencies assess the overall balance of health benefits and costs, no quantitative assessment of health inequality impact is consistently undertaken.

The inequality impact of technologies recommended under the NICE single technology appraisal process from 2012-2014 is assessed using an aggregate distributional cost-effectiveness framework. Data on health benefits, costs and patient populations are extracted from the NICE website. Benefits for each technology are distributed to social groups using the observed socioeconomic distribution of hospital utilisation for the targeted disease. Inequality measures and estimates of cost-effectiveness are compared using the health inequality impact plane and combined using social welfare indices.

Twenty-seven interventions are evaluated. 14 interventions are estimated to increase population health and reduce health inequality, eight to reduce population health and increase health inequality, and five to increase health and increase health inequality. Among the latter five, social welfare analysis, using inequality aversion parameters reflecting high concern for inequality, indicated that the health gain outweighs the negative health inequality impact.

The methods proposed offer a way of estimating the health inequality impacts of new health technologies. The methods do not allow for differences in technology-specific utilisation and health benefits, but require less resources and data than conducting full distributional cost-effectiveness analysis. They can provide useful quantitative information to help policy makers consider how far new technologies are likely to reduce or increase health inequalities.
Original languageEnglish
Pages (from-to)518
Number of pages526
JournalValue in Health
Issue number5
Publication statusPublished - 17 May 2019

Bibliographical note

© 2019, ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc.

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