Integrating Equity and Efficiency in Health Economic Evaluation: Development of Equity-Informed Methodologies in the French Healthcare Context (INEES Project)
Author(s)
Michael Mounié, PhD1, Romain Demeulemeester, PhD2, Benoît DERVAUX, PhD3, Coralie DELETTREZ, PhD4, Jennifer MARGIER, PhD5, Hassan Serrier, PhD6, Valéry-Pierre Riche, PharmD7, Christel CASTELLI, PhD8, Valérie Clément, PhD9, Huiyu SHANG, PhD student10, Laurent Molinier, MD, PhD2, Salah Ghabri, MSc, PhD11, Cyrille Delpierre, PhD12, Jerome Wittwer, PhD13, Pauline Chauvin, PhD14, Nadège COSTA15.
1Centre Hospitalier Universitaire de Toulouse, Toulouse, France, 2University Hospital of Toulouse, Toulouse, France, 3University Hospital of Lille - Pasteur Institute, Lille, France, 4University Hospital of Lille, Lille, France, 5Hospices Civils de Lyon, Lyon, France, 6Hospices Civils de Lyon, 69424 Lyon cedex 03, France, 7CHU de Nantes, Nantes, France, 8AESIO SANTE Research, Beausoleil Clinic, Montpellier, France, 9MRE, University of Montpellier, Montpellier, France, 10University of Paris Cité, Paris, France, 11French National Authority for Health (HAS), Paris, France, 12Inserm UMR1295-Centre d'Epidémiologie et de Recherche en santé des POPulations, Toulouse, France, 13Université de Bordeaux, Bordeaux, France, 14Université Paris Cité, Sorbonne Abu Dhabi University, Abu Dhabi, United Arab Emirates, 15Health Economist, University hospital of Toulouse, Toulouse, France.
1Centre Hospitalier Universitaire de Toulouse, Toulouse, France, 2University Hospital of Toulouse, Toulouse, France, 3University Hospital of Lille - Pasteur Institute, Lille, France, 4University Hospital of Lille, Lille, France, 5Hospices Civils de Lyon, Lyon, France, 6Hospices Civils de Lyon, 69424 Lyon cedex 03, France, 7CHU de Nantes, Nantes, France, 8AESIO SANTE Research, Beausoleil Clinic, Montpellier, France, 9MRE, University of Montpellier, Montpellier, France, 10University of Paris Cité, Paris, France, 11French National Authority for Health (HAS), Paris, France, 12Inserm UMR1295-Centre d'Epidémiologie et de Recherche en santé des POPulations, Toulouse, France, 13Université de Bordeaux, Bordeaux, France, 14Université Paris Cité, Sorbonne Abu Dhabi University, Abu Dhabi, United Arab Emirates, 15Health Economist, University hospital of Toulouse, Toulouse, France.
OBJECTIVES: Traditional economic evaluations in healthcare focus on efficiency but rarely address how health gains are distributed across populations. This project aims to develop, adapt, and test methodologies that explicitly integrate equity into economic evaluations to support fairer health decision-making in the French context.
METHODS: Two complementary approaches will be operationalized: (1) Equity weighting methods, which will adjust cost-effectiveness metrics using weights reflecting population vulnerability; and (2) Distributional Cost-Effectiveness Analysis (DCEA), which will quantify the redistributive impact of health interventions across socioeconomic groups. These methods will be adapted to the French healthcare system, using both aggregated and individual-level data (e.g., from administrative sources and clinical studies). A series of Algorithms and implementation guides will be developed, and the methodologies will be applied to multiple use cases (diabetes, cancer, depression, hearing loss, care coordination).
RESULTS: The project will generate enhanced cost-effectiveness estimates that incorporate socioeconomic variables. It is expected that applying these equity-informed methods will, in some cases, significantly shift the conclusions of conventional economic evaluations: interventions previously deemed efficient may appear less favorable when considering their distributive impact—and vice versa. The project will also produce practical tools (e.g., equity weighting tables, code libraries, methodological guides) for routine use. These results will help identify interventions most likely to reduce health inequalities while maintaining acceptable levels of efficiency.
CONCLUSIONS: The INEES project will deliver actionable, equity-sensitive economic evaluation tools tailored to the French context. By explicitly integrating both efficiency and equity, this project will contribute to the development of more socially responsive decision-making frameworks, with potential to inform HTA practices, resource allocation, and health policy at the national level.
METHODS: Two complementary approaches will be operationalized: (1) Equity weighting methods, which will adjust cost-effectiveness metrics using weights reflecting population vulnerability; and (2) Distributional Cost-Effectiveness Analysis (DCEA), which will quantify the redistributive impact of health interventions across socioeconomic groups. These methods will be adapted to the French healthcare system, using both aggregated and individual-level data (e.g., from administrative sources and clinical studies). A series of Algorithms and implementation guides will be developed, and the methodologies will be applied to multiple use cases (diabetes, cancer, depression, hearing loss, care coordination).
RESULTS: The project will generate enhanced cost-effectiveness estimates that incorporate socioeconomic variables. It is expected that applying these equity-informed methods will, in some cases, significantly shift the conclusions of conventional economic evaluations: interventions previously deemed efficient may appear less favorable when considering their distributive impact—and vice versa. The project will also produce practical tools (e.g., equity weighting tables, code libraries, methodological guides) for routine use. These results will help identify interventions most likely to reduce health inequalities while maintaining acceptable levels of efficiency.
CONCLUSIONS: The INEES project will deliver actionable, equity-sensitive economic evaluation tools tailored to the French context. By explicitly integrating both efficiency and equity, this project will contribute to the development of more socially responsive decision-making frameworks, with potential to inform HTA practices, resource allocation, and health policy at the national level.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
MSR133
Topic
Economic Evaluation, Health Policy & Regulatory, Methodological & Statistical Research