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.
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