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Distributional Cost‐Effectiveness Analysis of Health Care Programmes – A Methodological Case Study of the UK Bowel Cancer Screening Programme

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  • Miqdad Asaria
  • Susan Griffin
  • Richard Cookson
  • Sophie Whyte
  • Paul Tappenden

Abstract

This paper presents an application of a new methodological framework for undertaking distributional cost‐effectiveness analysis to combine the objectives of maximising health and minimising unfair variation in health when evaluating population health interventions. The National Health Service bowel cancer screening programme introduced in 2006 is expected to improve population health on average and to worsen population health inequalities associated with deprivation and ethnicity – a classic case of ‘intervention‐generated inequality’. We demonstrate the distributional cost‐effectiveness analysis framework by examining two redesign options for the bowel cancer screening programme: (i) the introduction of an enhanced targeted reminder aimed at increasing screening uptake in deprived and ethnically diverse neighbourhoods and (ii) the introduction of a basic universal reminder aimed at increasing screening uptake across the whole population. Our analysis indicates that the universal reminder is the strategy that maximises population health, while the targeted reminder is the screening strategy that minimises unfair variation in health. The framework is used to demonstrate how these two objectives can be traded off against each other, and how alternative social value judgements influence the assessment of which strategy is best, including judgements about which dimensions of health variation are considered unfair and judgements about societal levels of inequality aversion. © 2014 The Authors. Health Economics published by John Wiley & Sons Ltd.

Suggested Citation

  • Miqdad Asaria & Susan Griffin & Richard Cookson & Sophie Whyte & Paul Tappenden, 2015. "Distributional Cost‐Effectiveness Analysis of Health Care Programmes – A Methodological Case Study of the UK Bowel Cancer Screening Programme," Health Economics, John Wiley & Sons, Ltd., vol. 24(6), pages 742-754, June.
  • Handle: RePEc:wly:hlthec:v:24:y:2015:i:6:p:742-754
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    Blog mentions

    As found by EconAcademics.org, the blog aggregator for Economics research:
    1. Thesis Thursday: Miqdad Asaria
      by Chris Sampson in The Academic Health Economists' Blog on 2017-06-15 11:00:19
    2. Method of the month: Distributional cost effectiveness analysis
      by miqedup in The Academic Health Economists' Blog on 2018-09-12 06:00:57

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    Cited by:

    1. 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.
    2. Richard Cookson & Andrew Mirelman & Miqdad Asaria & Bryony Dawkins & Susan Griffin, 2016. "Fairer decisions, better health for all: Health equity and cost-effectiveness analysis," Working Papers 135cherp, Centre for Health Economics, University of York.
    3. Mitchell, Paul Mark & Roberts, Tracy E. & Barton, Pelham M. & Coast, Joanna, 2015. "Assessing sufficient capability: A new approach to economic evaluation," Social Science & Medicine, Elsevier, vol. 139(C), pages 71-79.
    4. repec:eee:socmed:v:198:y:2018:i:c:p:27-35 is not listed on IDEAS

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