Distributional Cost-Effectiveness Analysis Comes of Age

Cookson, Richard; Griffin, Susan; Norheim, Ole Frithjof; Culyer, Anthony J.; Chalkidou, Kalipso

doi:10.1016/j.jval.2020.10.001

Cited by 48 publications

(28 citation statements)

References 22 publications

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“…Methods of distributional costeffectiveness analysis are now available to make equity a measurable endpoint of health technology and health policy assessment. 128,129 If they are serious about tackling health inequalities then decision makers should start using these methods and routinely subject health technologies and policies to distributional analysis of their health equity impacts.…”

Section: Discussionmentioning

confidence: 99%

The inverse care law re-examined: a global perspective

et al. 2021

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An inverse care law persists in almost all low-income and middle-income countries, whereby socially disadvantaged people receive less, and lower-quality, health care despite having greater need. By contrast, a disproportionate care law persists in high-income countries, whereby socially disadvantaged people receive more health care, but of worse quality and insufficient quantity to meet their additional needs. Both laws are caused not only by financial barriers and fragmented health insurance systems but also by social inequalities in care seeking and co-investment as well as the costs and benefits of health care. Investing in more integrated universal health coverage and stronger primary care, delivered in proportion to need, can improve population health and reduce health inequality. However, trade-offs sometimes exist between health policy objectives. Health-care technologies, policies, and resourcing should be subjected to distributional analysis of their equity impacts, to ensure the health inequality reduction objective is kept in sight.

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Section: Discussionmentioning

confidence: 99%

The inverse care law re-examined: a global perspective

et al. 2021

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“…Such information is useful for those deciding on the e cient and equitable allocation of healthcare resources. It could also provide input to economic evaluations, such as distributional cost-effectiveness analysis (DCEA) [5].…”

Section: Trial Registrationmentioning

confidence: 99%

Health equity impact of community-initiated kangaroo mother care: A randomized controlled trial

Choudhary

Mazumder

Haaland

et al. 2021

Preprint

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BackgroundKangaroo mother care (KMC) can substantially enhance overall survival of low birthweight babies. In a large randomized controlled trial, we recently showed that supporting mothers to provide community initiated KMC (ciKMC) can reduce early infant mortality by 25% (hazard ratio (HR) 0.75). With the current analysis we aimed to explore if ciKMC promotion leads to increased inequity in survival.MethodsIn the trial we randomised 8402 low birthweight babies to a ciKMC (4480 babies) and a control (3922 babies) arm, between 2015 and 2018 in Haryana, India. The main outcome of interest was the difference in concentration indices between babies in the ciKMC and control arms for survival until 180 days of life.ResultsOur intervention did not increase survival inequity, as reflected in a reduction of the concentration index by 0.05 (95% CI -0.07 to 0.17). Survival impact tended to be higher among those born to illiterate mothers (HR 0.65, 95% CI 0.47 to 0.89), and those in poor families (HR 0.69, 95% CI 0.51 to 0.93).ConclusionsWe found that ciKMC promotion did not increase inequity in survival associated with wealth. The beneficial impact of ciKMC tended to be larger among vulnerable groups. Supporting mothers to provide KMC at home to low birthweight babies will not increase and could indeed reduce inequities in infant survival.Trial registrationClinicalTrials.gov, NCT02653534. Registered January 12, 2016 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02653534

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“…The challenge, therefore, lies in utilizing tools that can analyze inequities in health and its determinants in each phase. A number of references provide explicit methods or tools to guide the choice of HTA evaluators (13–15).…”

Section: Introductionmentioning

confidence: 99%

Development of a checklist to guide equity considerations in health technology assessment

Benkhalti

Espinoza

Cookson

et al. 2021

Int J Technol Assess Health Care

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Objectives Health technology assessment (HTA) can impact health inequities by informing healthcare priority-setting decisions. This paper presents a novel checklist to guide HTA practitioners looking to include equity considerations in their work: the equity checklist for HTA (ECHTA). The list is pragmatically organized according to the generic HTA phases and can be consulted at each step. Methods A first set of items was based on the framework for equity in HTA developed by Culyer and Bombard. After rewording and reorganizing according to five HTA phases, they were complemented by elements emerging from a literature search. Consultations with method experts, decision makers, and stakeholders further refined the items. Further feedback was sought during a presentation of the tool at an international HTA conference. Lastly, the checklist was piloted through all five stages of an HTA. Results ECHTA proposes elements to be considered at each one of the five HTA phases: Scoping, Evaluation, Recommendations and Conclusions, Knowledge Translation and Implementation, and Reassessment. More than a simple checklist, the tool provides details and examples that guide the evaluators through an analysis in each phase. A pilot test is also presented, which demonstrates the ECHTA's usability and added value. Conclusions ECHTA provides guidance for HTA evaluators wishing to ensure that their conclusions do not contribute to inequalities in health. Several points to build upon the current checklist will be addressed by a working group of experts, and further feedback is welcome from evaluators who have used the tool.

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Distributional Cost-Effectiveness Analysis Comes of Age

Cited by 48 publications

References 22 publications

The inverse care law re-examined: a global perspective

The inverse care law re-examined: a global perspective

Health equity impact of community-initiated kangaroo mother care: A randomized controlled trial

Development of a checklist to guide equity considerations in health technology assessment

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