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Distributional Cost-Effectiveness Analysis

Author

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  • Miqdad Asaria
  • Susan Griffin
  • Richard Cookson

Abstract

Distributional cost-effectiveness analysis (DCEA) is a framework for incorporating health inequality concerns into the economic evaluation of health sector interventions. In this tutorial, we describe the technical details of how to conduct DCEA, using an illustrative example comparing alternative ways of implementing the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP). The 2 key stages in DCEA are 1) modeling social distributions of health associated with different interventions, and 2) evaluating social distributions of health with respect to the dual objectives of improving total population health and reducing unfair health inequality. As well as describing the technical methods used, we also identify the data requirements and the social value judgments that have to be made. Finally, we demonstrate the use of sensitivity analyses to explore the impacts of alternative modeling assumptions and social value judgments.

Suggested Citation

  • Miqdad Asaria & Susan Griffin & Richard Cookson, 2016. "Distributional Cost-Effectiveness Analysis," Medical Decision Making, , vol. 36(1), pages 8-19, January.
    • Handle: RePEc:sae:medema:v:36:y:2016:i:1:p:8-19
    DOI: 10.1177/0272989X15583266
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    References listed on IDEAS

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    1. Thomas F. Crossley & Cormac O'Dea & Facundo Alvaredo & Anthony B. Atkinson & Salvatore Morelli, 2016. "The Challenge of Measuring UK Wealth Inequality in the 2000s," Fiscal Studies, Institute for Fiscal Studies, vol. 37, pages 13-33, March.
    2. Karl Claxton & Steve Martin & Marta Soares & Nigel Rice & Eldon Spackman & Sebastian Hinde & Nancy Devlin & Peter C Smith & Mark Sculpher, 2013. "Methods for the estimation of the NICE cost effectiveness threshold," Working Papers 081cherp, Centre for Health Economics, University of York.
    3. Paul Kind & Geoffrey Hardman & Susan Macran, 1999. "UK population norms for EQ-5D," Working Papers 172chedp, Centre for Health Economics, University of York.
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    2. Rachael Taylor & Deborah Sullivan & Penny Reeves & Nicola Kerr & Amy Sawyer & Emma Schwartzkoff & Andrew Bailey & Christopher Williams & Alexis Hure, 2023. "A Scoping Review of Economic Evaluations to Inform the Reorientation of Preventive Health Services in Australia," IJERPH, MDPI, vol. 20(12), pages 1-47, June.
    3. Dirk Steijger & Chandrima Chatterjee & Wim Groot & Milena Pavlova, 2022. "Challenges and Limitations in Distributional Cost-Effectiveness Analysis: A Systematic Literature Review," IJERPH, MDPI, vol. 20(1), pages 1-14, December.
    4. McNamara, Simon & Tsuchiya, Aki & Holmes, John, 2025. "Corrigendum to ‘Does the UK-public's aversion to inequalities in health differ by group-labelling and health-gain type? A choice-experiment’ [Soc. Sci. Med. Volume 269, January 2021, 113573]," Social Science & Medicine, Elsevier, vol. 370(C).
    5. Basu, Anirban, 2020. "A welfare-theoretic model consistent with the practice of cost-effectiveness analysis and its implications," Journal of Health Economics, Elsevier, vol. 70(C).
    6. Hill, Sarah R. & Vale, Luke & Hunter, David & Henderson, Emily & Oluboyede, Yemi, 2017. "Economic evaluations of alcohol prevention interventions: Is the evidence sufficient? A review of methodological challenges," Health Policy, Elsevier, vol. 121(12), pages 1249-1262.
    7. Wilkinson,Thomas David & Wang,Mengxiao & Friedman,Jed & Prestidge,Marelize, 2023. "A Framework for the Economic Evaluation of Digital Health Interventions," Policy Research Working Paper Series 10407, The World Bank.
    8. 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.
    9. Kirwin, Erin & Meacock, Rachel & Round, Jeff & Sutton, Matt, 2022. "The diagonal approach: A theoretic framework for the economic evaluation of vertical and horizontal interventions in healthcare," Social Science & Medicine, Elsevier, vol. 301(C).
    10. Paolo Candio & Koen B. Pouwels & David Meads & Andrew J. Hill & Laura Bojke & Claire Williams, 2022. "Modelling decay in effectiveness for evaluation of behaviour change interventions: a tutorial for public health economists," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(7), pages 1151-1157, September.
    11. Candio, Paolo & Meads, David & Hill, Andrew J. & Bojke, Laura, 2021. "Taking a local government perspective for economic evaluation of a population-level programme to promote exercise," Health Policy, Elsevier, vol. 125(5), pages 651-657.
    12. Saygın Avşar, Tuba & Yang, Xiaozhe & Lorgelly, Paula, 2024. "Equity in national healthcare economic evaluation guidelines: Essential or extraneous?," Social Science & Medicine, Elsevier, vol. 357(C).

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