Distributional Cost-Effectiveness Analysis: A Tutorial

Miqdad Asaria*, Susan Griffin, Richard Cookson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)8-19
Number of pages12
JournalMedical Decision Making
Issue number1
Early online date23 Apr 2015
Publication statusPublished - 1 Jan 2016

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© The Author(s) 2015. This is an author-produced version of the published paper. Uploaded in accordance with the publisher’s self-archiving policy. Further copying may not be permitted; contact the publisher for details


  • cost-effectiveness analysis
  • economic evaluation
  • efficiency
  • equality
  • equity
  • fairness
  • health distribution
  • health inequality
  • inequality measures
  • opportunity cost
  • social value judgments
  • social welfare functions
  • tradeoff

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