OBJECTIVES: Health inequalities in the UK are often described as unfair and avoidable differences in health between different groups within society. This research described and evaluated potential methods to measure impacts of health inequalities that could be used in health technology assessment (HTA) in the UK. The analysis included recommendations for current and future policy objectives relating to incorporating health inequalities.

METHODS: Pragmatic literature searches were conducted to identify approaches used to consider health inequalities around the world and the methods used to incorporate health inequalities in health economic evaluations. Stakeholder interviews and a workshop followed the review to discuss any gaps in the literature, reflect stakeholder views on health inequalities and understand the perspectives of decision makers.

RESULTS: All sampled HTA bodies performed no explicit and consistent quantification of health inequalities in the decision-making process. Five potential methods were identified to account for health inequalities, with equity-based weighting and distributional cost-effectiveness analysis considered the most feasible of the methods. Stakeholders reiterated that a deliberative process should remain the centre of HTA. Stakeholders also raised issues such as the burden on committees, trade-offs between complexity and accessibility, and the importance of measuring the size and direction of inequality impacts.

CONCLUSIONS: Based on current available evidence, both companies and the National Institute for Health and Care Excellence (NICE) should be more proactive in accounting for health inequalities. Companies should be encouraged to provide more quantitative analysis, as well as undertake training on the importance of inequalities. NICE should offer training for committee members on health inequalities, including new potential methods. Other recommendations included offering clarity on the weightings applied to health inequalities in healthcare decision making, updates to submission templates, and consistency in the application of methods.