Health economic analysis of distributional equity impacts – a call to action

November 3, 2021

Standard cost-effectiveness analysis (CEA) does not provide the information about distributional equity impacts that decision makers need to reduce unjust differences in health by socioeconomic status, ethnicity and other aspects of social disadvantage. As the convenors of two embryonic international networks of health economists interested in analysing distributional equity impacts, we believe that CEA and associated inter-disciplinary endeavours can and should evolve to support fairer decision making and better health outcomes for all social groups. 

In light of increasing recognition of the shortcomings of CEA, important advances have recently been made in health economic evaluation data and methods to better measure and communicate impacts on health equity. For example, distributional CEA and extended CEA provide distributional breakdowns of effects and costs to different social groups and allow analysis of  tradeoffs between overall gains in health and impacts on health equity, and a new handbook of equity methods in CEA has recently been published.

As well as methodological advances, efforts are under way to look beyond standard data sources that focus on average outcomes to study social distributions and enrich existing data sources. Researchers are also seeking to increase representation of vulnerable and marginalized communities in both trials and observational studies.

This progress in pioneering new methods and improved data signals an important step in the right direction. However, support and collaboration from all types of healthcare stakeholders will be needed to develop and use these equity-informative methods in decision making across geographies, and to establish new best practices. To this end, in 2019 the International Health Economics Association (iHEA) created a special interest group on equity informative evaluation to support improvement of methods for equity research, provide an opportunity for international collaboration, and focus on challenges unique to low- and middle- income countries (LMICs). A strategic priority is to increase the diversity of our leadership particularly focusing on researchers based within LMICs who are best placed to set the agenda.  Similarly, in 2021 the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) launched their special interest group for health equity research that aims to advance modeling, data and methods to better integrate equity considerations.

As the current convenors of these two embryonic international groups, we are keen to build an enthusiastic and diverse cadre of researchers who can play a role in advancing and localizing these methods. We welcome you to reach out, sign-up and get started.

We welcome you to reach out, sign-up and get started.

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