Equity and Health Inequalities: Should DCEA be Considered for Decision Making in the United Kingdom?
Author(s)
Rouse P1, Wodenitscharow K2
1Roche, Cambridgeshire, UK, 2Roche, Welwyn Garden City, HRT, UK
INTRODUCTION: In the UK, NICE uses cost-effectiveness analysis (CEA) to determine whether a technology will be reimbursed and provided within the NHS. However, CEA does not capture the impact of a new health technology on inequalities between population groups. Distributional cost-effectiveness analysis (DCEA), which is currently being explored in the NICE Methods review, is an additional “layer” that can be added to a CEA model to include formal analysis within the decision making process. OBJECTIVES: This work aims to understand the current common challenges and feasibility of implementing DCEA as a robust method to capture equity trade offs in the UK for decision making. METHODS: A targeted literature review of the previous five years was conducted to identify literature discussing key challenges with DCEA. PubMed, Cochrane Library, Medline, Embase were searched using standard search strings and DCEA specific terms such as “Distributional Cost-Effectiveness Analysis” “challenge(s)”, “weakness(es)”. The results were supplemented through a search of grey literature. Key challenges identified were compiled into common groups and evaluated in a UK specific context. RESULTS: A number of challenges were identified as part of the review that would need to be overcome in order to consider DCEA a robust method for decision making. Key challenges that were identified include where to set the trade-off threshold between the net health benefit and impact on inequality to reflect UK society preferences, availability of quality data and evaluation of small patient samples. CONCLUSIONS: Implementing DCEA methodology will allow decision making to move beyond the Incremental Cost-Effectiveness Ratio (ICER) threshold and incorporate the equity impact of a new technology. However, there are a number of key challenges that need to be considered before implementing DCEA into NICE decision making processes. Further research should be conducted into DCEA to assess whether the method can adequately incorporate health inequalities into these processes.
Conference/Value in Health Info
2021-11, ISPOR Europe 2021, Copenhagen, Denmark
Value in Health, Volume 24, Issue 12, S2 (December 2021)
Code
POSB131
Topic
Economic Evaluation, Health Policy & Regulatory
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis, Health Disparities & Equity, Reimbursement & Access Policy
Disease
No Specific Disease