IDEAS home Printed from https://ideas.repec.org/a/cup/hecopl/v4y2009i02p231-245_00.html
   My bibliography  Save this article

Explicit incorporation of equity considerations into economic evaluation of public health interventions

Author

Listed:
  • COOKSON, RICHARD
  • DRUMMOND, MIKE
  • WEATHERLY, HELEN

Abstract

Health equity is one of the main avowed objectives of public health policy across the world. Yet economic evaluations in public health (like those in health care more generally) continue to focus on maximizing health gain. Health equity considerations are rarely mentioned. Health economists rely on the quasi-egalitarian value judgment that ‘a QALY is a QALY’ – that is QALYs are equally weighted and the same health outcome is worth the same no matter how it is achieved or to whom it accrues. This value judgment is questionable in many important circumstances in public health. For example, policy-makers may place rather little value on health outcomes achieved by infringing individual liberties or by discriminating on the basis of age, sex, or race. Furthermore, there is evidence that a majority of the general public wish to give greater weight to health gains accruing to children, the severely ill, and, to a lesser extent, the socio-economically disadvantaged. This paper outlines four approaches to explicit incorporation of equity considerations into economic evaluation in public health: (i) review of background information on equity, (ii) health inequality impact assessment, (iii) analysis of the opportunity cost of equity, and (iv) equity weighting of health outcomes. The first three approaches can readily be applied using standard methods of health technology assessment, where suitable data are available; whereas approaches for generating equity weights remain experimental. The potential benefits of considering equity are likely to be largest in cases involving: (a) interventions that target disadvantaged individuals or communities and are also relatively cost-ineffective and (b) interventions to encourage lifestyle change, which may be relatively ineffective among ‘hard-to-reach’ disadvantaged groups and hence may require re-design to avoid increasing health inequalities.

Suggested Citation

  • Cookson, Richard & Drummond, Mike & Weatherly, Helen, 2009. "Explicit incorporation of equity considerations into economic evaluation of public health interventions," Health Economics, Policy and Law, Cambridge University Press, vol. 4(2), pages 231-245, April.
  • Handle: RePEc:cup:hecopl:v:4:y:2009:i:02:p:231-245_00
    as

    Download full text from publisher

    File URL: https://www.cambridge.org/core/product/identifier/S1744133109004903/type/journal_article
    File Function: link to article abstract page
    Download Restriction: no
    ---><---

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Tom L. Drake & Yoel Lubell & Shwe Sin Kyaw & Angela Devine & Myat Phone Kyaw & Nicholas P. J. Day & Frank M. Smithuis & Lisa J. White, 2017. "Geographic Resource Allocation Based on Cost Effectiveness: An Application to Malaria Policy," Applied Health Economics and Health Policy, Springer, vol. 15(3), pages 299-306, June.
    2. Stéphane Verguet & Jane J. Kim & Dean T. Jamison, 2016. "Extended Cost-Effectiveness Analysis for Health Policy Assessment: A Tutorial," PharmacoEconomics, Springer, vol. 34(9), pages 913-923, September.
    3. Stéphane Verguet & Ramanan Laxminarayan & Dean T. Jamison, 2015. "Universal Public Finance of Tuberculosis Treatment in India: An Extended Cost‐Effectiveness Analysis," Health Economics, John Wiley & Sons, Ltd., vol. 24(3), pages 318-332, March.
    4. Andrew J. Mirelman & Miqdad Asaria & Bryony Dawkins & Susan Griffin & Richard Cookson & Peter Berman, 2020. "Fairer Decisions, Better Health for All: Health Equity and Cost-Effectiveness Analysis," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 4, pages 99-132, World Scientific Publishing Co. Pte. Ltd..
    5. Olanrewaju Medu & Adegboyega Lawal & Doug Coyle & Kevin Pottie, 2021. "Economic evaluation of HIV testing options for low-prevalence high-income countries: a systematic review," Health Economics Review, Springer, vol. 11(1), pages 1-11, December.
    6. Gregory Merlo & Katie Page & Julie Ratcliffe & Kate Halton & Nicholas Graves, 2015. "Bridging the Gap: Exploring the Barriers to Using Economic Evidence in Healthcare Decision Making and Strategies for Improving Uptake," Applied Health Economics and Health Policy, Springer, vol. 13(3), pages 303-309, June.
    7. Kinge, Jonas Minet & Vallejo-Torres, Laura & Morris, Stephen, 2015. "Income related inequalities in avoidable mortality in Norway: A population-based study using data from 1994–2011," Health Policy, Elsevier, vol. 119(7), pages 889-898.
    8. Frank G. Sandmann & Julie V. Robotham & Sarah R. Deeny & W. John Edmunds & Mark Jit, 2018. "Estimating the opportunity costs of bed‐days," Health Economics, John Wiley & Sons, Ltd., vol. 27(3), pages 592-605, March.
    9. Luyten, Jeroen & Kessels, Roselinde & Atkins, Katherine E. & Jit, Mark & van Hoek, Albert Jan, 2019. "Quantifying the public's view on social value judgments in vaccine decision-making: A discrete choice experiment," Social Science & Medicine, Elsevier, vol. 228(C), pages 181-193.
    10. Weatherly, Helen & Drummond, Michael & Claxton, Karl & Cookson, Richard & Ferguson, Brian & Godfrey, Christine & Rice, Nigel & Sculpher, Mark & Sowden, Amanda, 2009. "Methods for assessing the cost-effectiveness of public health interventions: Key challenges and recommendations," Health Policy, Elsevier, vol. 93(2-3), pages 85-92, December.
    11. Ilias Goranitis & Joanna Coast & Ed Day & Alex Copello & Nick Freemantle & Emma Frew, 2017. "Maximizing Health or Sufficient Capability in Economic Evaluation? A Methodological Experiment of Treatment for Drug Addiction," Medical Decision Making, , vol. 37(5), pages 498-511, July.
    12. Lancsar, Emily & Gu, Yuanyuan & Gyrd-Hansen, Dorte & Butler, Jim & Ratcliffe, Julie & Bulfone, Liliana & Donaldson, Cam, 2020. "The relative value of different QALY types," Journal of Health Economics, Elsevier, vol. 70(C).
    13. E. Wetering & N. Exel & J. Rose & R. Hoefman & W. Brouwer, 2016. "Are some QALYs more equal than others?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(2), pages 117-127, March.
    14. Dukhanin, Vadim & Searle, Alexandra & Zwerling, Alice & Dowdy, David W. & Taylor, Holly A. & Merritt, Maria W., 2018. "Integrating social justice concerns into economic evaluation for healthcare and public health: A systematic review," Social Science & Medicine, Elsevier, vol. 198(C), pages 27-35.
    15. Jain, Vageesh & Crosby, Liam & Baker, Peter & Chalkidou, Kalipso, 2020. "Distributional equity as a consideration in economic and modelling evaluations of health taxes: A systematic review," Health Policy, Elsevier, vol. 124(9), pages 919-931.
    16. Anita Lal & Mohammad Siahpush & Marjory Moodie & Anna Peeters & Robert Carter, 2018. "Weighting Health Outcomes by Socioeconomic Position Using Stated Preferences," PharmacoEconomics - Open, Springer, vol. 2(1), pages 43-51, March.
    17. Anthony J. Culyer & Yvonne Bombard, 2012. "An Equity Framework for Health Technology Assessments," Medical Decision Making, , vol. 32(3), pages 428-441, May.
    18. Fan Yang & Colin Angus & Ana Duarte & Duncan Gillespie & Simon Walker & Susan Griffin, 2020. "Impact of Socioeconomic Differences on Distributional Cost-effectiveness Analysis," Medical Decision Making, , vol. 40(5), pages 606-618, July.
    19. Virginia Wiseman & Craig Mitton & Mary M. Doyle‐Waters & Tom Drake & Lesong Conteh & Anthony T. Newall & Obinna Onwujekwe & Stephen Jan, 2016. "Using Economic Evidence to Set Healthcare Priorities in Low‐Income and Lower‐Middle‐Income Countries: A Systematic Review of Methodological Frameworks," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 140-161, February.
    20. Laurence S. J. Roope & John Buckell & Frauke Becker & Paolo Candio & Mara Violato & Jody L. Sindelar & Adrian Barnett & Raymond Duch & Philip M. Clarke, 2020. "How Should a Safe and Effective COVID-19 Vaccine be Allocated? Health Economists Need to be Ready to Take the Baton," PharmacoEconomics - Open, Springer, vol. 4(4), pages 557-561, December.
    21. Simon McNamara & John Holmes & Abigail K. Stevely & Aki Tsuchiya, 2020. "How averse are the UK general public to inequalities in health between socioeconomic groups? A systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(2), pages 275-285, March.
    22. Candio, Paolo & Meads, David & Hill, Andrew J. & Bojke, Laura, 2020. "Modelling the impact of physical activity on public health: A review and critique," Health Policy, Elsevier, vol. 124(10), pages 1155-1164.
    23. Wouters, S. & van Exel, N.J.A. & Rohde, K.I.M. & Vromen, J.J. & Brouwer, W.B.F., 2017. "Acceptable health and priority weighting: Discussing a reference-level approach using sufficientarian reasoning," Social Science & Medicine, Elsevier, vol. 181(C), pages 158-167.
    24. Carlos Campillo-Artero & Jaume Puig-Junoy & Anthony J. Culyer, 2018. "Does MCDA Trump CEA?," Applied Health Economics and Health Policy, Springer, vol. 16(2), pages 147-151, April.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:cup:hecopl:v:4:y:2009:i:02:p:231-245_00. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: . General contact details of provider: https://www.cambridge.org/hep .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    We have no bibliographic references for this item. You can help adding them by using this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Keith Waters (email available below). General contact details of provider: https://www.cambridge.org/hep .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.