OBJECTIVES: We performed a systematic literature review to summarize patterns of applications of extended cost-effectiveness analysis (ECEA) and distributional cost-effectiveness analysis (DCEA) to gain a better understanding of when these analyses should be conducted to provide policymakers with relevant and meaningful evidence.

METHODS: We updated search strategies performed by Ward et. al., 2022 in PubMed, Embase, and EconLit, from January 2021 to August 2022. We included ECEA or DCEA of health interventions. Thematic analysis and content analysis were performed to analyze the patterns of application, study characteristics, and study findings to develop a set of characteristics of health systems and interventions that would contribute to a potential reduction in health inequity when conducting an ECEA or DCEA.

RESULTS: We identified 52 articles (35 ECEAs and 17 DCEAs). All of the included studies demonstrated positive findings with better health outcomes and lower health inequalities in different subgroups of the population. We identified themes of patterns of the application of ECEAs and DCEAs, including (1) providing evidence on the health equity impact of health interventions, (2) providing value-added to existing CEAs, (3) addressing existing health inequity, such as disease burden and financial risk, (4) quantifying estimates of a trade-off between efficiency and equity, and (5) achieving health systems’ goals. We identified three characteristics to determine when equity-informative CEAs should be conducted; (1) existence of health inequity in health systems, (2) local stakeholders’ awareness of the need to address health inequity, and (3) effectiveness of health interventions in reducing health inequity.

CONCLUSIONS: ECEAs and DCEAs have been increasingly conducted to inform policymakers on the value of a health intervention in reducing health inequity which is beyond the conventional CEAs. Stakeholder engagement is vital to ensure that these analyses align with policymakers’ needs.