Hosted by ISPOR Asia Consortium Industry Committee
3:15 PM – 4:15 PM, 14 May 2025
Montreal Convention Centre, Montreal, QC, Canada
The ISPOR Asia Consortium Industry Committee hosted a forum titled “How to Address Health Equity Gaps with HEOR and Policy Development in Asia Pacific” at ISPOR 2025 in Montreal. The objective of this session was to explore methodologies and practical approaches for integrating health equity into health technology assessment (HTA) and health economics and outcomes research (HEOR) to inform policy development across the Asia Pacific region. The forum was moderated by Stacey Kowal, MSc, Senior Director of Public Policy Evidence at Genentech, USA. Three distinguished speakers shared insights from recent research and policy applications, highlighting both progress and persistent challenges in advancing health equity through evidence-based decision-making.
An Overview of Health Equity Issues and Opportunities in Asia Pacific
Nathorn (Nui) Chaiyakunapruk, PharmD, PhD, Professor, University of Utah College of Pharmacy, USA
Dr. Chaiyakunapruk presented findings from a landscape analysis of health equity integration within HTA processes across 13 health systems in Asia. He reported that while most systems claim to consider equity—particularly for rare diseases, high-burden conditions, and socially disadvantaged groups (e.g., low-income or rural populations)—the implementation remains inconsistent and often informal. Equity considerations are most frequently applied during the decision-making stage, with limited systematic integration in earlier phases such as topic selection or appraisal. Only a few countries, including China, Thailand, and Singapore, have begun piloting formal equity-informative methods such as distributional cost-effectiveness analysis (DCEA), primarily in academic settings. Dr. Chaiyakunapruk emphasized the need for standardized frameworks, improved methodological guidance, and enhanced analytical capacity to ensure equity is consistently and transparently embedded throughout HTA. He also called for stronger baseline data on disparities and greater regional collaboration to support more equitable healthcare policy and reimbursement decisions.
Incorporating Health Equity into Cost-Effectiveness Analysis: Indicators, Data, and Methods
Stacey Kowal, MSc, Senior Director, Public Policy Evidence, Genentech, USA
Ms. Kowal discussed the growing global momentum to place health equity at the center of HTA, citing initiatives from agencies such as the Institute for Clinical and Economic Review (ICER) in the US and the National Institute for Health and Care Excellence (NICE) in the UK. She focused on distributional cost-effectiveness analysis (DCEA) as a promising tool for evaluating both efficiency and equity impacts, allowing analysts to assess how health gains and resource allocation costs are distributed across different population subgroups. She also highlighted methods for eliciting societal preferences toward health inequality reduction, such as trade-off exercises and discrete choice experiments. Drawing on examples from high- and middle-income countries, Kowal underscored the importance of aligning equity methods with local data availability and priorities, investing in data infrastructure, and fostering cross-sector collaboration to support equity-informed policy.
Minimizing Health Equity Gaps Through HEOR-Informed Policy: Case Studies from China
Xiaoning He, PhD, Associate Professor, Tianjin University, China
Dr. He shared recent progress on incorporating health equity into HTA in China, focusing on the development and application of distributional cost-effectiveness analysis (DCEA). Her team constructed a county-level social deprivation index (CSDI) using 2020 census data, identifying significant geographic disparities correlated with health outcomes such as infant mortality and life expectancy. The analysis revealed a 7.74-year gap in quality-adjusted life expectancy (QALE) between the most and least deprived groups. Through large-scale surveys, her team also elicited public and decision-maker preferences regarding inequality aversion, finding support for integrating equity into HTA—though decision-makers preferred more moderate trade-offs between equity and efficiency. Dr. He concluded that both the public and policymakers in China support health equity integration, and future work will involve estimating opportunity cost thresholds and applying DCEA in real-world policy contexts.
Key Takeaways and Future Directions
The forum concluded with a moderated discussion highlighting several consistent themes:
- There is strong and growing recognition of the importance of health equity in HTA and HEOR across Asia Pacific, but implementation remains uneven.
- Robust methods such as DCEA offer promising pathways to quantify and integrate equity considerations but require local adaptation, better data, and capacity building.
- Engaging multiple stakeholders—including the public, policymakers, and researchers—is essential to defining equity priorities and implementing effective policies.
- Regional collaboration and knowledge-sharing can accelerate progress toward more equitable healthcare systems.
The session underscored the critical role of HEOR and evidence-informed policy in addressing health inequities and promoting sustainable healthcare development throughout the Asia Pacific region.