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Equity-efficiency trade-offs in health technology assessment
Alan H Williams1, Richard A Cookson
1Centre for Health Economics, University of York, UK.
Summary
Health technology assessment (HTA) must evolve beyond efficiency to address equity concerns. Future stages propose quantitative formulas for impartial, transparent decision-making on health equity-efficiency trade-offs.
Area of Science:
- Health Economics
- Public Health Policy
- Decision Science
Background:
- Current health technology assessment (HTA) prioritizes efficiency over equity, potentially widening socioeconomic health disparities.
- Intuitive management of equity-efficiency trade-offs lacks transparency and democratic legitimacy.
Purpose of the Study:
- To propose a framework for advancing health technology assessment (HTA) decision-making beyond current efficiency-focused models.
- To explore the progression of resource allocation principles towards quantitative, impartial methods for managing equity-efficiency trade-offs.
Main Methods:
- Review of historical resource allocation models to identify stages of development (case law, codification, quantitative formulas).
- Examination of existing methodologies for valuing equity-efficiency trade-offs using established principles.
- Analysis of public perception data on the inequity of different health disparities (social class, smoking, sex).
Main Results:
- A four-stage model for decision-making progression is proposed, culminating in quantitative formulas for impartial application.
- Public opinion suggests varying perceptions of inequity across different social strata, smoking status, and sex-based health differences.
- Opportunity costs of departing from strict cost-effectiveness analysis can quantify the weight of equity concerns.
Conclusions:
- Transitioning HTA to a quantitative, formula-based approach (Stage 4) offers transparency and impartiality in managing equity-efficiency trade-offs.
- Further data collection is needed to credibly calculate relative weights for equity concerns in policy.
- Estimating opportunity costs provides a metric for evaluating the societal value placed on specific equity considerations.
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