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Health Equity Considerations in Cost-Effectiveness Analysis: Insights from an Umbrella Review
Jeffrey M Muir1, Amruta Radhakrishnan1, Ipek Ozer Stillman2
1RWA Health Economics, Cytel Inc., Toronto, ON, Canada.
Clinicoeconomics and Outcomes Research : CEOR
|August 26, 2024
Summary
Integrating health equity into cost-effectiveness analyses (CEA) is crucial for healthcare decisions. This review found various methods like distributional CEA (DCEA) and extended CEA (ECEA), but consensus and consistent use remain challenging.
Area of Science:
- Health Economics
- Public Health Policy
- Health Equity Research
Background:
- Cost-effectiveness analyses (CEA) are vital for healthcare resource allocation.
- There is growing interest in expanding CEA scope to include health equity considerations.
- Integrating equity aims to ensure fair distribution of health benefits.
Purpose of the Study:
- To synthesize evidence on how health equity concepts are incorporated into modified CEAs.
- To identify common approaches and challenges in applying equity-focused CEA.
- To inform future methodologies for equitable healthcare decision-making.
Main Methods:
- An umbrella review of systematic literature reviews (SLRs) published since 2013.
- Searched MEDLINE for SLRs incorporating health equity in CEA.
- Qualitative synthesis of findings from eight included SLRs.
Main Results:
- Distributional CEA (DCEA), equity-based weighting, extended CEA (ECEA), and MCDA were prominent approaches.
- Lack of consensus on the optimal method for incorporating health equity into CEA.
- Significant limitations include data scarcity, metric bias, and challenges with contextual factors like fairness.
Conclusions:
- Extended and distributional CEAs can highlight inequity impacts on treatment assessment.
- Challenges persist due to data gaps, methodological complexity, and decision-maker unfamiliarity.
- Standardized data collection and increased familiarity with methodologies are recommended for advancing equity in CEA.
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