Abstract
Purpose: This study uses routinely collected health data to conduct a distributional cost-effectiveness analysis (DCEA) of a current National Health Service (NHS) policy to examine its impact on area of residence socioeconomic inequalities in quality-adjusted life expectancy. We conducted a DCEA for the NHS Abdominal Aortic Aneurysm Screening Programme (NAAASP) for men aged 65 years in England. Abdominal Aortic Aneurysm (AAA) has a high mortality rate for those affected by rupture and is twice as common among those in the most socioeconomically deprived decile of the population versus the least deprived decile. Inequalities in access and uptake of care occur along the screening and treatment pathway.
Methods: A previously developed discrete event simulation model of AAA screening was adapted to examine differences between socioeconomic groups defined by the Index of Multiple Deprivation (IMD). We obtained routinely collected registry data from the NAAASP and the National Vascular Registry in England, and adapted model parameters to account for differences between IMD groups. Costs were updated to 2020/2021 British pound sterling. We examined the distributional cost-effectiveness of being versus not being invited to screen for AAA over a lifetime time horizon, using an NHS health and personal social services perspective. Results were estimated in terms of changes in net quality-adjusted life expectancy for the population of men aged 65 in England in 2019, split into subgroups based on the quintile of IMD. Using an estimate for the level of inequality aversion for England, we use an equity-efficiency impact plane to illustrate the dual impact on overall population health and health inequality associated with the NAAASP.
Results: Overall, while absolute health was expected to improve across all IMD subgroups through the NAAASP, the total health benefits were disproportionately accounted for by impacts on the most advantaged. Inviting, relative to not inviting, men to screen for AAA improved total population health while increasing health inequality.
Conclusion: In this study, routinely collected data informed the staircase of inequality along the AAA screening pathway. Study findings demonstrate the impact of the NAAASP on population health and health inequality.
Methods: A previously developed discrete event simulation model of AAA screening was adapted to examine differences between socioeconomic groups defined by the Index of Multiple Deprivation (IMD). We obtained routinely collected registry data from the NAAASP and the National Vascular Registry in England, and adapted model parameters to account for differences between IMD groups. Costs were updated to 2020/2021 British pound sterling. We examined the distributional cost-effectiveness of being versus not being invited to screen for AAA over a lifetime time horizon, using an NHS health and personal social services perspective. Results were estimated in terms of changes in net quality-adjusted life expectancy for the population of men aged 65 in England in 2019, split into subgroups based on the quintile of IMD. Using an estimate for the level of inequality aversion for England, we use an equity-efficiency impact plane to illustrate the dual impact on overall population health and health inequality associated with the NAAASP.
Results: Overall, while absolute health was expected to improve across all IMD subgroups through the NAAASP, the total health benefits were disproportionately accounted for by impacts on the most advantaged. Inviting, relative to not inviting, men to screen for AAA improved total population health while increasing health inequality.
Conclusion: In this study, routinely collected data informed the staircase of inequality along the AAA screening pathway. Study findings demonstrate the impact of the NAAASP on population health and health inequality.
| Original language | English |
|---|---|
| Publication status | Unpublished - 2023 |
| Event | HESG Oxford - Oxford, United Kingdom Duration: 21 Jun 2023 → 23 Jun 2023 |
Conference
| Conference | HESG Oxford |
|---|---|
| Country/Territory | United Kingdom |
| City | Oxford |
| Period | 21/06/23 → 23/06/23 |