Presentation (CTI)

OBJECTIVES: Distributional cost-effectiveness analysis (DCEA) methods were developed to help decision makers consider maximising population health while reducing inequalities. The methods for conducting aggregate DCEA were developed using England-specific data sets. The objective of this study was to conduct a literature search in selected countries to identify equivalent data sources that could be used to inform aggregate DCEA.
METHODS: A series of targeted and pragmatic searches were used to identify possible data sources in a sample of five countries: Australia, Brazil, Canada, India and Spain. Searches were conducted using Governmental/National websites, health agency websites, published literature reviews, Ovid Medline and targeted web searches. There were seven areas that made up the aggregated DCEA feasibility literature search: healthcare utilisation; major population health survey data; inequalities or deprivation data by geographic area; national opportunity cost thresholds and associated empirical evidence; evidence on baseline inequalities in lifetime health; evidence related to the distribution of health opportunity costs; inequality aversion parameters.
RESULTS: Of the five countries assessed, no single country had all the necessary data to conduct a DCEA. However, aggregate DCEA is still possible in all the countries, apart from India. Australia had the highest level of available data, with all but one of the necessary components without requiring assumptions to populate a DCEA. Where there were data gaps, recommendations were made for assumptions that could be used in place of the missing data. Further recommendations were made on approaches for future evidence collection to support DCEA.
CONCLUSIONS: Aggregate DCEA has components that rely on data that may not be available in all countries. However, in these cases DCEA may still be useful and reasonable assumptions can be made in the case of missing data. This research can help to promote internationally consistent methods for HTA agencies considering inequalities alongside maximising population health.