Abstract

The systematic review by Merga et al examining economic evaluations that address inequalities in cancer care had a striking result in that only 13% of studies identified used distributional cost-effectiveness analysis (DCEA). DCEA provides a structured approach to quantifying equity impacts in economic evaluations by measuring changes in health outcome distributions before and after introducing an intervention. Although stratified CEA (or equity impact analyses) can show how costs and benefits are distributed across different groups, DCEA offers advantages, perhaps most importantly, by allowing for the explicit quantification and analysis of trade-offs between improving total population health and reducing health inequalities.