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Eliciting Trade-Offs Between Equity and Efficiency: A Methodological Scoping Review.

Christopher J Cadham1, Lisa A Prosser2

  • 1Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.

Value in Health : the Journal of the International Society for Pharmacoeconomics and Outcomes Research
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PubMed
Summary

Studies show varied methods for assessing healthcare equity-efficiency trade-offs. Results indicate mixed preferences for equity, highlighting the need for standardized approaches in cost-effectiveness analysis.

Keywords:
distributional cost-effectiveness analysisdistributional weightsequity weightingequity-efficiency trade-offsequity-informative cost-effectiveness analysisinequality aversionpreference rankingsocial welfare function

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Area of Science:

  • Health Economics
  • Health Policy
  • Social Welfare Analysis

Background:

  • Healthcare resource allocation requires balancing efficiency with equity.
  • Understanding societal preferences for equity is crucial for informed decision-making.
  • Existing studies on equity-efficiency trade-offs exhibit considerable methodological diversity.

Purpose of the Study:

  • To systematically review and compare methods used to elicit equity-efficiency trade-offs in health economics.
  • To identify differences in study approaches and outcomes to inform equity-informative cost-effectiveness analysis.
  • To synthesize findings on societal preferences for equity in healthcare resource allocation.

Main Methods:

  • A comprehensive literature search was conducted across Ovid (Medline), EconLit, and Scopus.
  • Inclusion criteria focused on survey-based studies quantifying inequality aversion or eliciting equity-efficiency trade-offs.
  • Studies were categorized by approach: social welfare function parameterization or preference ranking/distributional weighting.

Main Results:

  • Seventy-seven studies were included, with 28 using social welfare functions and 49 using preference ranking/distributional weighting.
  • Significant heterogeneity was observed in study methodologies, sample characteristics, and question framing across 29 countries.
  • Evidence for inequality aversion was mixed: 39 studies showed clear evidence, 33 found mixed evidence, and 4 found none.

Conclusions:

  • Methodological variability hinders direct comparison of findings and application in equity-informed cost-effectiveness analysis.
  • Future research should employ representative samples and investigate heterogeneity within and between countries.
  • Standardized methodologies are needed to improve the utility of equity-efficiency trade-off studies for healthcare policy.