Steps Health Professionals Can Take to Reduce Inequality in Health Outcomes

That is the title of an article in AJMC co-authored with Meena Venkatachalam. An excerpt is below:

While decision-makers traditionally have ignored the issue of inequality, academic researchers have already developed tools to quantify a treatment’s value from reductions in inequality. Two common methods for doing so are distributional cost effectiveness analysis (DCEA) and multiple-criteria decision analysis (MCDA). DCEA values treatments not only based on health gains and cost but also whether these health gains accrue to disadvantaged groups.7

The approach is similar to traditional cost effectiveness analysis but health gains—typically measured in QALYs—are estimated by patient subgroup. Subgroups are defined by patient groups where, in theory, differences in health outcomes should not be seen but exist due to inequality–e.g. gender, education, socioeconomic status, race, etc. For each of these subgroups, QALY gains are weighted based on whether they accrue to patients with worse than average outcomes at baseline (up-weighted), or better than average outcomes at baseline (down-weighted). While DCEA is a bit more complicated than traditional CEA, it does provide a single, simple measure of value often expressed as an incremental cost per QALY gained.

Do read the entire article.

Using HEOR Methods to Reduce Health Inequalities

Join me tomorrow, 9/26, 12:00 PM EDT, as PRECISIONheor’s Jason Shafrin and Meena Venkatachalam discuss their recent blog commentary in the health policy journal Health Affairs on how novel methods of Cost-Effectiveness Analysis can be used to expand traditional value frameworks improve health outcomes for underserved communities. Moderated by Precision’s Kelly Wilder, there will be a live Q&A following the webinar. REGISTER HERE.

Creating Incentives To Narrow The Gap In Health Outcomes

That is the title of my recent blog post in Health Affairs with my co-author Meena Venkatachalam. The subtitle is “Expanding Value Assessment To Incorporate Health Inequality“. An excerpt is below:

The brutal murder of George Floyd has brought renewed attention to systemic inequality that African Americans and other minorities face in the United States and around the world. These inequalities also appear in health outcomes statistics. According to the Centers for Disease Control and Prevention (CDC), while African Americans represented 13 percent of the US population, as of May 30, 22 percent of COVID-19 patients were black. Furthermore, as of March 30, 33 percent of hospitalized COVID-19 patients were African American. These health disparities were well known before the COVID-19 pandemic; life expectancy for African Americans in the US is 3.5 years lower than for the American population as a whole. Furthermore, the average African American can expect to spend 13 years of his or her life without health insurance, compared to only eight years for the typical non-Hispanic white. Although there is a universal acknowledgement that health inequalities need to be addressed, the question is “How?”

To find the answer do read the entire post. We discuss approaches using distributional cost effectiveness analysis (DCEA) and multiple-criteria decision analysis (MCDA). If equity matters to policymakers and payers, economists have developed the tools to incorporate the value of reduced inequality into formal value assessment. We conclude by saying:

While improving health outcomes for African Americans and other marginalized groups requires leveraging a multifaceted approach, appropriately incentivizing innovations that help those who need it most is one step that both policy makers and life sciences firms can agree on is a way to fairly make sure that equity is appropriately valued.

Do read the whole article.