Exploring Frameworks and Methodologies to Incorporate Equity in Health Economics Evaluation: A Scoping Review

OBJECTIVES: To identify approaches for incorporating equity considerations in economic evaluation practice.

METHODS: We searched PubMed to identify literature published during ten years prior to January 19, 2023, that proposed analysis methods or frameworks to facilitate equity-informed economic evaluations. We included peer-reviewed articles in English that proposed, discussed, or used methods to consider equity, disparity, or social determinants of health in economic evaluations. We excluded articles that: (1) only documented disparity or inequity problems, (2) were conceptual discussions without providing methodologies or framework, or (3) simply reported subgroup analyses without considering equity as a primary objective of the study. Identified studies were categorized as: (1) Engagement and process, (2) Methods and data, (3) Communication and use. The categories were identified as key action domains based on preliminary literature reviews and inputs from 40 stakeholders with various backgrounds (academia, industry, patient groups, etc.) via individual interviews and roundtable discussions.

RESULTS: Seventy-four papers were included after full text review, 12 related to engagement and process, 49 related to methods and data, and 17 related to communication and use. Although studies could relate to more than one category, none of the included studies covered all three action domains. For articles categorized in methods and data domain, distributional cost-effectiveness analysis (DCEA) was the most frequently used or discussed method (n=19), followed by Markov-model approaches focusing on equity (n=12). Current literature exhibits great heterogeneity regarding equity-focused evaluation processes. The most frequently discussed challenge was lack of disaggregated data to perform equity-informed evaluations.

CONCLUSIONS: Equity-related health economic literature has focused more on methods, with less attention to engagement processes or communication of results. Data challenges also limit equity-focused economic evaluation practice. The broad focus of this review on equity in economic evaluation processes, methods, and communication shows that more comprehensive equity-focused evaluation frameworks may be necessary.