Distributional Cost-Effectiveness Analysis: Quantifying Health Equity Impacts and Trade-Offs

Distributional cost-effectiveness analysis aims to help health care and public health organisations make fairer decisions with better outcomes. Whereas standard cost-effectiveness analysis provides information about total costs and effects, distributional cost-effectiveness analysis provides additional information about fairness in the distribution of costs and effects - who gains, who loses, and by how much. It can also provide information about the trade-offs that sometimes occur between efficiency objectives, such as improving total health, and equity objectives, such as reducing unfair inequality in health.

This is a practical guide to a flexible suite of economic methods for quantifying the equity consequences of health programmes in high-, middle- and low-income countries. The methods can be tailored and combined in various ways to provide useful information to different decision-makers in different countries with different distributional equity concerns. The handbook is primarily aimed at postgraduate students and analysts specialising in cost-effectiveness analysis but is also accessible to a broader audience of health sector academics, practitioners, managers, policymakers and stakeholders.

As well as offering an overview for research commissioners, users, and producers, the book includes systematic technical guidance on how to simulate and evaluate distributions, with accompanying hands-on spreadsheet training exercises, and discussions about how to handle uncertainty about facts and disagreement about values, and the future challenges facing this young and rapidly evolving field of study.

Richard Cookson, Professor, Centre for Health Economics, University of York, UK, Susan Griffin, Senior Research Fellow, Centre for Health Economics, University of York, UK, Ole F. Norheim, Professor, Department of Global Public Health, University of Bergen, Norway, Anthony J. Culyer, ProfessorEmeritus, University of York, UK

Richard Cookson is a professor at the Centre for Health Economics, University of York, England. He has helped to pioneer ＂equity-informative＂ methods of health policy analysis including methods of distributional cost-effectiveness analysis, methods of health equity monitoring for healthcare quality assurance, and methods for investigating public concern for reducing health inequality. He has co-chaired various international working groups on equity, and his UK public service includes working in the Prime Minister’s Delivery Unit and serving on NICE advisory committees and the NHS Advisory Committee for Resource Allocation.

Susan Griffin is a Senior Research Fellow at the Centre for Health Economics, University of York. Throughout her career, she has developed methods for economic evaluation and produced research that supports decision-makers investing in healthcare and health research to improve health and reduce health inequalities. Her research interests include the use of decision-analytic models in cost-effectiveness analysis and value of information analysis. Susan leads research on public health and health inequality in two policy research units for the Department of Health and Social Care in the UK. She has contributed to technology appraisals undertaken by the National Institute for Health and Care Excellence (NICE) as a member of one of the independent academic groups undertaking assessments and evidence reviews, as a member of the Technology Appraisal Committee, and in the development of methods used at NICE.

Ole F. Norheim is a physician and professor of medical ethics, Department of Global Public Health and Primary Care, the University of Bergen, and adjunct professor of global health at the Department of Global Health and Population, Harvard TH Chan School of Public Health. He directs the Bergen Centre for Ethics and Priority Setting (BCEPS) at the University of Bergen. Norheim’s wide-ranging research interests include theories of distributive justice, inequality in health, priority setting in health systems, and how to achieve Universal Health Coverage and the Sustainable Development Goal for health. Norheim chaired the World Health Organization’s Consultative Group on Equity and Universal Health Coverage (2012-2014) and the third Norwegian National Committee on Priority Setting in Health Care (2013-2014).

Anthony J. Culyer is emeritus professor of economics at York (England); Senior Fellow at the Institute of Health Policy, Management and Evaluation at the University of Toronto; Visiting Professor at Imperial College London, and Chair of the International Decision Support Initiative. He was the founding Organiser of the UK Health Economists’ Study Group. For 33 years he was the founding co-editor, with Joe Newhouse, of the Journal of Health Economics. He was founding Vice-Chair of the National Institute for Health and Care Excellence (NICE). For many years he was chair of the Department of Economics & Related Studies at York and, for six of them, was also deputy vice-chancellor. He has received many honours and has published widely, mostly in health economics. The third edition of his The Dictionary of Health Economics (Edward Elgar) came out in 2014. A collection of his non-technical essays called The Humble Economist is available on-line free of charge.