Addressing Health Equity in Cost-Effectiveness Analysis: A Review of Distributional and Extended Cost-Effectiveness Analysis

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dc.contributor.advisorSinanovic, Edina
dc.contributor.authorLewis, Ian Storm
dc.date.accessioned2022-03-04T08:46:21Z
dc.date.available2022-03-04T08:46:21Z
dc.date.issued2021
dc.date.updated2022-03-03T12:29:58Z
dc.description.abstractBackground Equity is rarely included in health economic evaluations, partly because the techniques for addressing equity have been inadequate. Since 2013 health economists have developed two competing health economic technologies: distributional costeffectiveness analysis (DCEA) and extended cost-effectiveness analysis (ECEA). Both technologies represent a significant advance, and each provides a framework to address equity considerations in cost-effectiveness analysis. Methods A scoping literature review was used to identify and synthesise the relevant literature on incorporating equity concerns into economic evaluations. A second focused review identified literature which discussed or applied DCEA and ECEA. Key themes in the literature were identified using NVivo qualitative data analysis software. Results The review revealed three key areas of difference between DCEA and ECEA: First, the analysis of trade-offs between improving health and reducing inequity; second, the analysis of financial impacts of health policies; and third, the incorporation of opportunity costs. ECEA can analyse financial risk protection while DCEA can analyse opportunity costs and trade-offs between improving equity and reducing health. ECEA is designed for low- and middle-income countries, whereas DCEA is better suited to developed health systems such as the National Health Service in the United Kingdom. To date, there have been 27 studies using ECEA and five studies using DCEA. Future developments for DCEA and ECEA include incorporating alternative methods to simplify the data requirements for the techniques, providing methods to assist decision makers to clarify their equity concerns, and improving the presentation of outcomes to make them accessible to non-specialists. Conclusions DCEA and ECEA are both economic frameworks which address equity considerations in cost-effectiveness analysis. This study examines and compares these two techniques in order to assist policymakers and decision makers to determine which of the two methods is best able to address their specific needs for their particular circumstances.
dc.identifier.apacitationLewis, I. S. (2021). <i>Addressing Health Equity in Cost-Effectiveness Analysis: A Review of Distributional and Extended Cost-Effectiveness Analysis</i>. (). ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/35910en_ZA
dc.identifier.chicagocitationLewis, Ian Storm. <i>"Addressing Health Equity in Cost-Effectiveness Analysis: A Review of Distributional and Extended Cost-Effectiveness Analysis."</i> ., ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2021. http://hdl.handle.net/11427/35910en_ZA
dc.identifier.citationLewis, I.S. 2021. Addressing Health Equity in Cost-Effectiveness Analysis: A Review of Distributional and Extended Cost-Effectiveness Analysis. . ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. http://hdl.handle.net/11427/35910en_ZA
dc.identifier.ris TY - Master Thesis AU - Lewis, Ian Storm AB - Background Equity is rarely included in health economic evaluations, partly because the techniques for addressing equity have been inadequate. Since 2013 health economists have developed two competing health economic technologies: distributional costeffectiveness analysis (DCEA) and extended cost-effectiveness analysis (ECEA). Both technologies represent a significant advance, and each provides a framework to address equity considerations in cost-effectiveness analysis. Methods A scoping literature review was used to identify and synthesise the relevant literature on incorporating equity concerns into economic evaluations. A second focused review identified literature which discussed or applied DCEA and ECEA. Key themes in the literature were identified using NVivo qualitative data analysis software. Results The review revealed three key areas of difference between DCEA and ECEA: First, the analysis of trade-offs between improving health and reducing inequity; second, the analysis of financial impacts of health policies; and third, the incorporation of opportunity costs. ECEA can analyse financial risk protection while DCEA can analyse opportunity costs and trade-offs between improving equity and reducing health. ECEA is designed for low- and middle-income countries, whereas DCEA is better suited to developed health systems such as the National Health Service in the United Kingdom. To date, there have been 27 studies using ECEA and five studies using DCEA. Future developments for DCEA and ECEA include incorporating alternative methods to simplify the data requirements for the techniques, providing methods to assist decision makers to clarify their equity concerns, and improving the presentation of outcomes to make them accessible to non-specialists. Conclusions DCEA and ECEA are both economic frameworks which address equity considerations in cost-effectiveness analysis. This study examines and compares these two techniques in order to assist policymakers and decision makers to determine which of the two methods is best able to address their specific needs for their particular circumstances. DA - 2021_ DB - OpenUCT DP - University of Cape Town KW - Health equity KW - inequality KW - cost-effectiveness analysis KW - distributional cost-effectiveness analysis (DCEA) KW - extended cost-effectiveness analysis (ECEA) LK - https://open.uct.ac.za PY - 2021 T1 - Addressing Health Equity in Cost-Effectiveness Analysis: A Review of Distributional and Extended Cost-Effectiveness Analysis TI - Addressing Health Equity in Cost-Effectiveness Analysis: A Review of Distributional and Extended Cost-Effectiveness Analysis UR - http://hdl.handle.net/11427/35910 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/35910
dc.identifier.vancouvercitationLewis IS. Addressing Health Equity in Cost-Effectiveness Analysis: A Review of Distributional and Extended Cost-Effectiveness Analysis. []. ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2021 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/35910en_ZA
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Public Health and Family Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.subjectHealth equity
dc.subjectinequality
dc.subjectcost-effectiveness analysis
dc.subjectdistributional cost-effectiveness analysis (DCEA)
dc.subjectextended cost-effectiveness analysis (ECEA)
dc.titleAddressing Health Equity in Cost-Effectiveness Analysis: A Review of Distributional and Extended Cost-Effectiveness Analysis
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMPH
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