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Distributional cost-effectiveness analysis: a tutorial

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  • Asaria, Miqdad
  • Griffin, Susan
  • Cookson, Richard

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

  • Asaria, Miqdad & Griffin, Susan & Cookson, Richard, 2016. "Distributional cost-effectiveness analysis: a tutorial," LSE Research Online Documents on Economics 101271, London School of Economics and Political Science, LSE Library.
  • Handle: RePEc:ehl:lserod:101271
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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. Fleurbaey, Marc & Schokkaert, Erik, 2009. "Unfair inequalities in health and health care," Journal of Health Economics, Elsevier, vol. 28(1), pages 73-90, January.
    3. Miqdad Asaria & Susan Griffin & Richard Cookson & Sophie Whyte & Paul Tappenden, 2013. "Distributional Cost-Effectiveness Analysis of Health Care Programmes," Working Papers 091cherp, Centre for Health Economics, University of York.
    4. 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.
    5. Shorrocks, Anthony F, 1983. "Ranking Income Distributions," Economica, London School of Economics and Political Science, vol. 50(197), pages 3-17, February.
    6. 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.
    7. Atkinson, Anthony B., 1970. "On the measurement of inequality," Journal of Economic Theory, Elsevier, vol. 2(3), pages 244-263, September.
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    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. Asaria, Miqdad & Mazumdar, Sumit & Chowdhury, Samir & Mazumdar, Papiya & Mukhopadhyay, Abhiroop & Gupta, Indrani, 2019. "Socioeconomic inequality in life expectancy in India," LSE Research Online Documents on Economics 100783, London School of Economics and Political Science, LSE Library.
    3. Dolly Han & Nicolas Iragorri & Fiona Clement & Diane Lorenzetti & Eldon Spackman, 2018. "Cost Effectiveness of Treatments for Chronic Constipation: A Systematic Review," PharmacoEconomics, Springer, vol. 36(4), pages 435-449, April.
    4. Simon Walker & Susan Griffin & Miqdad Asaria & Aki Tsuchiya & Mark Sculpher, 2019. "Striving for a Societal Perspective: A Framework for Economic Evaluations When Costs and Effects Fall on Multiple Sectors and Decision Makers," Applied Health Economics and Health Policy, Springer, vol. 17(5), pages 577-590, October.
    5. Deidda, Manuela & Geue, Claudia & Kreif, Noemi & Dundas, Ruth & McIntosh, Emma, 2019. "A framework for conducting economic evaluations alongside natural experiments," Social Science & Medicine, Elsevier, vol. 220(C), pages 353-361.
    6. Miqdad Asaria, 2017. "Health care costs in the English NHS: reference tables for average annual NHS spend by age, sex and deprivation group," Working Papers 147cherp, Centre for Health Economics, University of York.
    7. James Love-Koh & Susan Griffin & Edward Kataika & Paul Revill & Sibusiso Sibandze & Simon Walker, 2019. "Incorporating concerns for equity into health resource allocation. A guide for practitioners," Working Papers 160cherp, Centre for Health Economics, University of York.
    8. Jessica Ochalek & Karl Claxton & Paul Revill & Mark Sculpher & Alexandra Rollinger, 2016. "Supporting the development of an essential health package: principles and initial assessment for Malawi," Working Papers 136cherp, Centre for Health Economics, University of York.
    9. Helen Weatherly & Rita Faria & Bernard Van den Berg & Mark Sculpher & Peter O’Neill & Kay Nolan & Julie Glanville & Jaana Isojarvi & Erin Baragula & Mary Edwards, 2017. "Scoping review on social care economic evaluation methods," Working Papers 150cherp, Centre for Health Economics, University of York.
    10. 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.
    11. 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.
    12. McNamara, Simon & Tsuchiya, Aki & Holmes, John, 2021. "Does the UK-public's aversion to inequalities in health differ by group-labelling and health-gain type? A choice-experiment," Social Science & Medicine, Elsevier, vol. 269(C).
    13. 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.
    14. 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.
    15. 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.

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    More about this item

    Keywords

    cost-effectiveness analysis; economic evaluation; efficiency; equality; equity; fairness; health distribution; health inequality; inequality measures; opportunity cost; social value judgments; social welfare functions; tradeoff;
    All these keywords.

    JEL classification:

    • J50 - Labor and Demographic Economics - - Labor-Management Relations, Trade Unions, and Collective Bargaining - - - General

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