IDEAS home Printed from https://ideas.repec.org/a/spr/aphecp/v23y2025i5d10.1007_s40258-025-00972-x.html
   My bibliography  Save this article

Aggregate Distributional Cost-Effectiveness Analysis of Biologics for the Treatment of Ankylosing Spondylitis in Chile

Author

Listed:
  • Magdalena Walbaum

    (London School of Economics and Political Science)

  • Nicolas Jana-Valencia

    (Kings College London)

Abstract

Background and Objective Ankylosing spondylitis is a complex rheumatic disease, characterised by chronic and progressive inflammation of the spine, causing an important health and economic burden for the person with the condition. Evidence shows the unequal impact of the disease in different groups of people, with a higher burden for lower socioeconomic groups. The objective of this study is to evaluate the impact of the use of biologics for the treatment of ankylosing spondylitis on health inequities in Chile. Methods We conducted an aggregate distributional cost-effectiveness analysis. Data on health outcomes and costs were derived from a cost-effectiveness model of secukinumab, etanercept, certolizumab pegol, infliximab, adalimumab and golimumab versus treatment as usual for the treatment of ankylosing spondylitis from the Chilean healthcare system perspective. Health gains and health opportunity costs were distributed across socioeconomic subgroups. Health and equity impacts, measured using the Atkinson index, were assessed on an equity-efficiency impact plane. Results All treatments had a positive impact on equity relative to treatment as usual. At an opportunity cost threshold of 1 Gross Domestic Product per capita/quality-adjusted life-year, secukinumab improved societal welfare irrespective of the Atkinson index value. When varying thresholds (2 and 3 Gross Domestic Product), all assessed technologies contributed to an increase in societal welfare, regardless of the Atkinson index. Conclusions Biologic treatment for ankylosing spondylitis, such as secukinumab, may reduce health inequity in the Chilean population. An aggregate distributional cost-effectiveness analysis framework is feasible to implement alongside a cost-effectiveness analysis in the context of the Chilean healthcare system to provide additional information of equity impacts for health technology assessment recommendations and policy making.

Suggested Citation

  • Magdalena Walbaum & Nicolas Jana-Valencia, 2025. "Aggregate Distributional Cost-Effectiveness Analysis of Biologics for the Treatment of Ankylosing Spondylitis in Chile," Applied Health Economics and Health Policy, Springer, vol. 23(5), pages 905-918, September.
    • Handle: RePEc:spr:aphecp:v:23:y:2025:i:5:d:10.1007_s40258-025-00972-x
    DOI: 10.1007/s40258-025-00972-x
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s40258-025-00972-x
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s40258-025-00972-x?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to

    for a different version of it.

    References listed on IDEAS

    as
    1. James Love-Koh & Richard Cookson & Karl Claxton & Susan Griffin, 2020. "Estimating Social Variation in the Health Effects of Changes in Health Care Expenditure," Medical Decision Making, , vol. 40(2), pages 170-182, February.
    2. Matthew Robson & Miqdad Asaria & Richard Cookson & Aki Tsuchiya & Shehzad Ali, 2017. "Eliciting the Level of Health Inequality Aversion in England," Health Economics, John Wiley & Sons, Ltd., vol. 26(10), pages 1328-1334, October.
    3. Cookson, Richard & Mirelman, Andrew J. & Griffin, Susan & Asaria, Miqdad & Dawkins, Bryony & Norheim, Ole Frithjof & Verguet, Stéphane & J. Culyer, Anthony, 2017. "Using cost-effectiveness analysis to address health equity concerns," LSE Research Online Documents on Economics 101230, London School of Economics and Political Science, LSE Library.
    4. Susan Griffin & James Love-Koh & Becky Pennington & Lesley Owen, 2019. "Evaluation of Intervention Impact on Health Inequality for Resource Allocation," Medical Decision Making, , vol. 39(3), pages 171-182, April.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Love-Koh, James & Pennington, Becky & Owen, Lesley & Taylor, Matthew & Griffin, Susan, 2020. "How health inequalities accumulate and combine to affect treatment value: A distributional cost-effectiveness analysis of smoking cessation interventions," Social Science & Medicine, Elsevier, vol. 265(C).
    2. 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.
    3. 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.
    4. Fan Yang & Ana Duarte & Simon Walker & Susan Griffin, 2021. "Uncertainty Analysis in Intervention Impact on Health Inequality for Resource Allocation Decisions," Medical Decision Making, , vol. 41(6), pages 653-666, August.
    5. 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.
    6. Richard Cookson & Shehzad Ali & Aki Tsuchiya & Miqdad Asaria, 2018. "E‐learning and health inequality aversion: A questionnaire experiment," Health Economics, John Wiley & Sons, Ltd., vol. 27(11), pages 1754-1771, November.
    7. 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.
    8. Kruse, Tobias & Atkinson, Giles, 2022. "Understanding public support for international climate adaptation payments: Evidence from a choice experiment," Ecological Economics, Elsevier, vol. 194(C).
    9. Robson, Matthew & O’Donnell, Owen & Van Ourti, Tom, 2024. "Aversion to health inequality — Pure, income-related and income-caused," Journal of Health Economics, Elsevier, vol. 94(C).
    10. Joan Costa-Font & Frank Cowell, 2025. "Specific egalitarianism? Inequality aversion across domains," The Journal of Economic Inequality, Springer;Society for the Study of Economic Inequality, vol. 23(3), pages 749-775, September.
    11. Fan Yang & Colin Angus & Ana Duarte & Duncan Gillespie & Mark Sculpher & Simon Walker & Susan Griffin, 2021. "Comparing smoking cessation to screening and brief intervention for alcohol in distributional cost effectiveness analysis to explore the sensitivity of results to socioeconomic inequalities characteri," Working Papers 184cherp, Centre for Health Economics, University of York.
    12. 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).
    13. Susan Griffin & James Love-Koh & Becky Pennington & Lesley Owen, 2019. "Evaluation of Intervention Impact on Health Inequality for Resource Allocation," Medical Decision Making, , vol. 39(3), pages 171-182, April.
    14. Miqdad Asaria & Susan Griffin & Richard Cookson, 2013. "Distributional cost-effectiveness analysis: a tutorial," Working Papers 092cherp, Centre for Health Economics, University of York.
    15. Sebastian Hinde & Dan Howdon & James Lomas & Matthew Franklin, 2022. "Health Inequalities: To What Extent are Decision-Makers and Economic Evaluations on the Same Page? An English Case Study," Applied Health Economics and Health Policy, Springer, vol. 20(6), pages 793-802, November.
    16. Michael Drummond & Aleksandra Torbica & Rosanna Tarricone, 2020. "Should health technology assessment be more patient centric? If so, how?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(8), pages 1117-1120, November.
    17. Erik Schokkaert & Benoît Tarroux, 2021. "Empirical research on ethical preferences: how popular is prioritarianism?," Working Papers 2104, Groupe d'Analyse et de Théorie Economique Lyon St-Étienne (GATE Lyon St-Étienne), Université de Lyon.
    18. Attema, Arthur E. & L'Haridon, Olivier & van de Kuilen, Gijs, 2023. "Decomposing social risk preferences for health and wealth," Journal of Health Economics, Elsevier, vol. 90(C).
    19. 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.
    20. Christopher McCabe, 2019. "Expanding the Scope of Costs and Benefits for Economic Evaluations in Health: Some Words of Caution," PharmacoEconomics, Springer, vol. 37(4), pages 457-460, 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:spr:aphecp:v:23:y:2025:i:5:d:10.1007_s40258-025-00972-x. See general information about how to correct material in RePEc.

    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.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with 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: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

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

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.