title: Distributional Cost-Effectiveness Analysis: A Tutorial.
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.
authors.affiliation: Centre for Health Economics, University of York, York, UK (MA, SG, RC).
authors.forename: Miqdad
authors.initials: M
authors.lastname: Asaria
authors.affiliation: Centre for Health Economics, University of York, York, UK (MA, SG, RC).
authors.forename: Susan
authors.initials: S
authors.lastname: Griffin
authors.affiliation: Centre for Health Economics, University of York, York, UK (MA, SG, RC).
authors.forename: Richard
authors.initials: R
authors.lastname: Cookson
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D003362:Cost-Benefit Analysis; D055088:Early Detection of Cancer / Q000191:economics*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013222:State Medicine / Q000191:economics*; D006113:United Kingdom
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