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The Risk Of Perpetuating Health Disparities Through Cost-Effectiveness Analyses.
Sanjay Basu1, Atheendar S Venkataramani2, Dean Schillinger3
1Sanjay Basu (sanjay.basu@waymarkcare.org), Waymark, San Francisco, California.
Health Affairs (Project Hope)
|August 5, 2024
Summary
Standard cost-effectiveness analyses may underestimate intervention benefits for marginalized groups. Adjusting for health inequities and structural factors is crucial for fair health policy decisions.
Area of Science:
- Health Economics
- Health Equity Research
- Public Health Policy
Background:
- Cost-effectiveness analyses (CEAs) are vital for health policy but may perpetuate inequities.
- Standard CEAs can disadvantage marginalized populations by assuming persistent health disparities.
Purpose of the Study:
- To examine how competing risks, baseline costs, and indirect costs affect CEAs for minority populations.
- To highlight how structural factors can reduce estimated intervention benefits for disadvantaged groups.
Main Methods:
- Analysis of structural factors influencing CEA outcomes.
- Illustrative examples using interventions like sugar-sweetened beverage taxes.
Main Results:
- Structural factors can decrease quality-adjusted life-years and cost savings for minority groups.
- Interventions may appear less cost-effective for disadvantaged populations due to these factors.
- Differences in competing risks and insurance status impact CEA results.
Conclusions:
- Current CEA methods may systematically disadvantage marginalized communities.
- Alternative CEA approaches are needed to account for structural factors and reduce inequities.
- Health equity sensitivity analyses can support interventions benefiting disadvantaged populations.
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