Examining Equity Effects of Health Interventions in Cost-Effectiveness Analysis: A Systematic Review

Abstract

This systematic review aims to catalogue and describe published applications of equity-informative costeffectiveness analysis (CEAs).Methods: Following PRISMA guidelines, we searched Medline for English-language, peer-reviewed CEAs published on or before August 2019. We included CEAs that evaluated 2 or more alternatives; explicitly mentioned equity as a consideration or decision-making principle; and applied an equity-informative CEA method to analyze or examine at least 1 equity criterion in an applied CEA. We extracted data on selected characteristics and analyzed reporting quality using the CHEERS checklist.Results: Fifty-four articles identified through a search and bibliography reviews met the inclusion criteria. All articles were published on or after 2010, with 80% published after 2015. Most studies evaluated primary prevention interventions in disease areas such as cancer, infectious diseases, and cardiovascular disease. Equity impact analysis alone was the most common equityinformative CEA (56%), followed by equity impact analysis with financial protection effects (30%). At least 11 different equity criteria have been used in equity-informative CEAs; socioeconomic status and race/ethnicity were used most frequently. Seventy-eight percent of studies reported finding "greater value" in an intervention after examining its distributional effects. Conclusion:The number of equity-informative CEAs is increasing, and the wide range of equity criteria, diseases, interventions, settings, and populations represented suggests that broad application of these methods is feasible but will require further refinement. Inclusion of equity into CEAs may shift the value of evaluated interventions and can provide crucial additional information for decision makers.

Principles of Economic Evaluation in a Pandemic Setting: An Expert Panel Discussion on Value Assessment During the Coronavirus Disease 2019 Pandemic

“…When valuing therapeutics for a pandemic that has a disproportionate impact on particular subsets of the population, it is advisable to consider methods that can account for any differential impacts. The distributional form of cost-effectiveness analysis (DCEA) evaluates interventions with differential impacts on socioeconomic subgroups and compares the magnitude in each group [26,27]. In lieu of a full DCEA, which would require trial data or a decision-analytic model to empirically inform the distribution of effects, Love-Koh et al describe an aggregate DCEA for health technologies that rolls up existing data alongside a measure of inequality [28].…”

Innovations in cost-effectiveness analysis that advance equity can expand its use in health policy

“…Our recent systematic review found that the number of equity-informative CEAs is increasing, and they have been used to estimate the cost-effectiveness of interventions for a wide range of diseases in several countries. 11 We found that at least nine dimensions of health equity, from socioeconomic status to race and ethnicity, have been reflected in equity-informative CEAs to date. These results suggest that equity-informative CEAs have the potential to address various health equity concerns in CEA that several HTA agencies explicitly consider in their decision-making.…”

Avoiding health technology assessment: a global survey of reasons for not using health technology assessment in decision making

“…HTA practitioners also need to consider how issues such as equity and affordability can be better incorporated into HTA methods to allay the concerns of those opposed to HTA. Though methods for the incorporation of equity into HTA have been developed, they remain underutilised [ 19 , 30 ]. Methods of communication with policymakers, researchers and civil society also need to be improved on these issues.…”