Development of a Stepwise Approach to Assessing the Feasibility of Conducting a Distributional Cost-Effectiveness Analysis

OBJECTIVES: The importance of incorporating health equity into health technology assessment is increasingly being recognized and Distributional Cost-Effectiveness Analysis (DCEA) is emerging as a potential quantitative method. DCEA can be either aggregate or full form. Aggregate DCEA is often favored due to lower data and resource requirements but does not provide the complete perspective offered by a full DCEA. DCEA methods currently lack a practical, step-by-step process for assessing feasibility of conducting a DCEA, whether in aggregate or full form. This study aimed to fill that gap by developing such an approach.

METHODS: A process for assessing the feasibility of conducting a DCEA was developed which involved creating key feasibility criteria, using lung cancer as a case study. Criteria considered included equity domains, and how equity staircase model parameters might vary by equity subgroups. A key consideration was also data availability and the quality of available data sources. Likely stakeholder acceptance was evaluated when developing the feasibility approach.

RESULTS: A stepwise process was developed for assessing the feasibility of conducting DCEA. This process includes six steps, starting with selecting the equity-relevant subgroup. Next, parameters that may vary by the equity subgroup are identified (e.g., eligible population, treatment effectiveness and uptake). After identifying these parameters, the next step is to identify potential data sources that could be used to provide model estimates. Data sources identified are then assessed in terms of their accessibility, content and quality using a standardized process.

CONCLUSIONS: The approach developed assesses the feasibility of conducting a DCEA and determines the most suitable methodology. Steps can be modified based on resource availability; for example, whilst we conducted a targeted literature search for data sources, a systematic literature review could be performed for completeness. It is hoped that this new approach will help with the wider adoption of DCEA.