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CAN COST-EFFECTIVENESS ANALYSIS INTEGRATE CONCERNS FOR EQUITY? SYSTEMATIC REVIEW

Published online by Cambridge University Press:  12 April 2012

Mira Johri  and
Ole Frithjof Norheim
Mira Johri
Affiliation:
University of Montreal email: mira.johri@umontreal.ca
Ole Frithjof Norheim
Affiliation:
University of Bergen
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Abstract

Objectives: The aim of this study was to promote approaches to health technology assessment (HTA) that are both evidence-based and values-based. We conducted a systematic review of published studies describing formal methods to consider equity in the context of cost-effectiveness analysis (CEA).

Methods: Candidate studies were identified through an unrestricted search of the Pub Med and EMBASE databases. The search closed on January 20, 2011. We identified additional studies by consulting experts and checking article bibliographies. Two authors independently reviewed each candidate study to determine inclusion and extracted data from studies retained for review. In addition to documenting methods, data extraction identified implicit and explicit notions of fairness. Data were synthesized in narrative form. Study quality was not assessed.

Results: Of the 695 candidate articles, 51 were retained for review. We identified three broad methods to facilitate quantitative consideration of equity concerns in economic evaluation: integration of distributional concerns through equity weights and social welfare functions, exploration of the opportunity costs of alternative policy options through mathematical programming, and multi-criteria decision analysis.

Conclusions: Several viable techniques to integrate equity concerns within CEA now exist, ranging from descriptive approaches to the quantitative methods studied in this review. Two obstacles at the normative level have impeded their use in decision making to date: the multiplicity of concepts and values discussed under the rubric of equity, and the lack of a widely accepted normative source on which to ground controversial value choices. Clarification of equity concepts and attention to procedural fairness may strengthen use of these techniques in HTA decision making.

Keywords

Cost-benefit analysisQuality-adjusted life-yearsResource allocationHealth carerationinghealth prioritiesequity
Type
METHODS
Information
International Journal of Technology Assessment in Health Care , Volume 28 , Issue 2 , April 2012 , pp. 125 - 132
Copyright
Copyright © Cambridge University Press 2012

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References

REFERENCES

1.ANAND, P.QALYS and the integration of claims in health-care rationing. Health Care Anal. 1999;7:239–253.CrossRefGoogle ScholarPubMed
2.Anand, P.The integration of claims to health-care: A programming approach. J Health Econ. 2003;22:731–745.CrossRefGoogle ScholarPubMed
3.Baltussen, R, Niessen, L. Priority setting of health interventions: The need for multi-criteria decision analysis. Cost Eff Resour Alloc. 2006;4:14.CrossRefGoogle ScholarPubMed
4.Baltussen, R, Stolk, E, Chisholm, D, Aikins, M. Towards a multi-criteria approach for priority setting: An application to Ghana. Health Econ. 2006;15:689–696.CrossRefGoogle ScholarPubMed
5.Baltussen, R, ten Asbroek, AH, Koolman, X, et al. Priority setting using multiple criteria: Should a lung health programme be implemented in Nepal? Health Policy Plan. 2007;22:178–185.Google Scholar
6.Birch, S, Gafni, A. Cost effectiveness/utility analyses. Do current decision rules lead us to where we want to be? J Health Econ. 1992;11:279–296.CrossRefGoogle ScholarPubMed
7.Bleichrodt, H. Health utility indices and equity considerations. J Health Econ. 1997;16:65–91.CrossRefGoogle ScholarPubMed
8.Bleichrodt, H, Diecidue, E, Quiggin, J. Equity weights in the allocation of health care: The rank-dependent QALY model. J Health Econ. 2004;23:157–171.CrossRefGoogle ScholarPubMed
9.Brock, D. Empirical ethics, moral philosophy, and the democracy problem. In: Murray, CJ, Salomon, JA, Mathers, C, Lopez, AD, eds. Summary measures of population health. Geneva: World Health Organisation; 2003.Google Scholar
10.Cantor, SB. Cost-effectiveness analysis, extended dominance, and ethics: A quantitative assessment. Med Decis Making. 1994;14:259–265.Google Scholar
11.Cleary, S, Mooney, G, McIntyre, D. Equity and efficiency in HIV-treatment in South Africa: The contribution of mathematical programming to priority setting. Health Econ. 2010;19:1166–1180.CrossRefGoogle ScholarPubMed
12.Cookson, R, Drummond, M, Weatherly, H. Explicit incorporation of equity considerations into economic evaluation of public health interventions. Health Econ Policy Law. 2009;4 (Pt 2):231–245.Google Scholar
13.Daniels, N.Just health: Meeting health needs fairly. Cambridge: Cambridge University Press; 2007.CrossRefGoogle Scholar
14.Dolan, P. The measurement of individual utility and social welfare. J Health Econ. 1998;17:39–52.CrossRefGoogle ScholarPubMed
15.Drummond, MF, Sculpher, MJ, Torrance, GW, O'Brien, BJ, Stoddart, GL. Methods for the economic evaluation of health care programmes. New York: Oxford University Press; 2005.CrossRefGoogle Scholar
16.Earnshaw, SR, Richter, A, Sorensen, SW, et al. Optimal allocation of resources across four interventions for type 2 diabetes. Med Decis Making. 2002; 22 (Suppl):S80–S91.CrossRefGoogle ScholarPubMed
17.Epstein, DM, Chalabi, Z, Claxton, K, Sculpher, M. Efficiency, equity, and budgetary policies: Informing decisions using mathematical programming. Med Decis Making. 2007;27:128–137.CrossRefGoogle ScholarPubMed
18.Fishkin, JS.Democracy and deliberation: New directions for democratic reform. New Haven, CT: Yale University Press; 1991.Google Scholar
19.Goetghebeur, MM, Wagner, M, Khoury, H, et al. Combining multicriteria decision analysis, ethics and health technology assessment: Applying the EVIDEM decision-making framework to growth hormone for Turner syndrome patients. Cost Eff Resour Alloc. 2010;8:4.CrossRefGoogle ScholarPubMed
20.Jehu-Appiah, C, Baltussen, R, Acquah, C, et al. Balancing equity and efficiency in health priorities in Ghana: The use of multicriteria decision analysis. Value Health. 2008;11:1081–1087.CrossRefGoogle ScholarPubMed
21.Johannesson, M. Should we aggregate relative or absolute changes in QALYs? Health Econ. 2001;10:573–577.CrossRefGoogle ScholarPubMed
22.Johri, M, Damschroder, LJ, Zikmund-Fisher, BJ, Ubel, PA. The importance of age in allocating health care resources: Does intervention-type matter? Health Econ. 2005;14:669–678.CrossRefGoogle ScholarPubMed
23.Kaplan, EH, Merson, MH. Allocating HIV-prevention resources: Balancing efficiency and equity. Am J Public Health. 2002;92:1905–1907.CrossRefGoogle ScholarPubMed
24.Lindholm, L, Rosen, M. On the measurement of the nation's equity adjusted health. Health Econ. 1998;7:621–628.3.0.CO;2-Y>CrossRefGoogle ScholarPubMed
25.Lindholm, L, Rosen, M, Emmelin, M. How many lives is equity worth? A proposal for equity adjusted years of life saved. J Epidemiol Community Health. 1998;52:808–811.CrossRefGoogle Scholar
26.Lloyd, AJ. Threats to the estimation of benefit: Are preference elicitation methods accurate? Health Econ. 2003;12:393–402.CrossRefGoogle Scholar
27.Makundi, E, Kapiriri, L, Norheim, OF. Combining evidence and values in priority setting: Testing the balance sheet method in a low-income country. BMC Health Serv Res. 2007;7:152.CrossRefGoogle Scholar
28.Mortimer, D. The value of thinly spread QALYs. Pharmacoeconomics. 2006;24:845–853.CrossRefGoogle ScholarPubMed
29.Nord, E.Cost-value analysis in health care: Making sense out of QALYs. Cambridge: Cambridge University Press; 1999.CrossRefGoogle Scholar
30.Nord, E, Pinto, JL, Richardson, J, Menzel, P, Ubel, P. Incorporating societal concerns for fairness in numerical valuations of health programmes. Health Econ. 1999;8:25–39.Google Scholar
31.Norheim, OF, Asada, Y. The ideal of equal health revisited: Definitions and measures of inequity in health should be better integrated with theories of distributive justice. Int J Equity Health. 2009;8:40.CrossRefGoogle ScholarPubMed
32.Rodriguez, E, Pinto, JL. The social value of health programmes: Is age a relevant factor? Health Econ. 2000;9:611–621.3.0.CO;2-R>CrossRefGoogle ScholarPubMed
33.Rodriguez-Miguez, E, Pinto-Prades, JL. Measuring the social importance of concentration or dispersion of individual health benefits. Health Econ. 2002;11:43–53.CrossRefGoogle ScholarPubMed
34.Sassi, F, Archard, L, Le Grand, J. Equity and the economic evaluation of healthcare. Health Technol Assess. 2001;5:i+iii–130.Google Scholar
35.Schwappach, DL. Resource allocation, social values and the QALY: A review of the debate and empirical evidence. Health Expect. 2002;5:210–222.CrossRefGoogle ScholarPubMed
36.Sen, A.On economic inequality. New Delhi: Oxford University Press; 1997.Google Scholar
37.Shah, KK. Severity of illness and priority setting in healthcare: A review of the literature. Health Policy. 2009;93:77–84.CrossRefGoogle ScholarPubMed
38.Stinnett, AA, Paltiel, AD. Mathematical programming for the efficient allocation of health care resources. J Health Econ. 1996;15:641–653.CrossRefGoogle ScholarPubMed
39.Stolk, EA, van Donselaar, G, Brouwer, WB, Busschbach, JJ. Reconciliation of economic concerns and health policy: Illustration of an equity adjustment procedure using proportional shortfall. Pharmacoeconomics. 2004;22:1097–1107.CrossRefGoogle ScholarPubMed
40.The Global Equity Gauge Alliance. The equity gauge: Concepts, principles, and guidelines. Durban: Global Equity Gauge Alliance and Health Systems Trust; 2003.Google Scholar
41.Tsuchiya, A. Age-related preferences and age weighting health benefits. Soc Sci Med. 1999;48:267–276.Google Scholar
42.Tsuchiya, A, Dolan, P, Shaw, R. Measuring people's preferences regarding ageism in health: Some methodological issues and some fresh evidence. Soc Sci Med. 2003;57:687–696.Google Scholar
43.Tsuchiya, A, Williams, A. A “fair innings” between the sexes: Are men being treated inequitably? Soc Sci Med. 2005;60:277–286.CrossRefGoogle Scholar
44.Ubel, PA. How stable are people's preferences for giving priority to severely ill patients? Soc Sci Med. 1999;49:895–903.Google Scholar
45.Ubel, PA, DeKay, ML, Baron, J, Asch, DA. Cost-effectiveness analysis in a setting of budget constraints–is it equitable? N Engl J Med. 1996;334:1174–1177.CrossRefGoogle Scholar
46.Wagstaff, A. QALYs and the equity-efficiency trade-off. J Health Econ. 1991;10:21–41.CrossRefGoogle ScholarPubMed
47.Weatherly, H, Drummond, M, Claxton, K, et al. Methods for assessing the cost-effectiveness of public health interventions: Key challenges and recommendations. Health Policy. 2009;93:85–92.CrossRefGoogle ScholarPubMed
48.Williams, A. Intergenerational equity: An exploration of the ‘fair innings’ argument. Health Econ. 1997;6:117–132.3.0.CO;2-B>CrossRefGoogle ScholarPubMed
49.Wolfson, M, Rowe, G. On measuring inequalities in health. Bull World Health Organ. 2001;79:553–560.Google ScholarPubMed
50.World Health Organization. Health systems: Improving performance. World Health Report Geneva, Switzerland: World Health Organization; 2000:i–141.Google Scholar
51.Zaric, GS, Brandeau, ML. Optimal investment in a portfolio of HIV prevention programs. Med Decis Making. 2001;21:391–408.CrossRefGoogle Scholar
52.Zenios, SA, Wein, LM, Chertow, GM. Evidence-based organ allocation. Am J Med. 1999;107:52–61.CrossRefGoogle ScholarPubMed
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