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Explicit incorporation of equity considerations into economic evaluation of public health interventions

  • RICHARD COOKSON (a1), MIKE DRUMMOND (a2) and HELEN WEATHERLY (a2)
Abstract
Abstract

Health equity is one of the main avowed objectives of public health policy across the world. Yet economic evaluations in public health (like those in health care more generally) continue to focus on maximizing health gain. Health equity considerations are rarely mentioned. Health economists rely on the quasi-egalitarian value judgment that ‘a QALY is a QALY’ – that is QALYs are equally weighted and the same health outcome is worth the same no matter how it is achieved or to whom it accrues. This value judgment is questionable in many important circumstances in public health. For example, policy-makers may place rather little value on health outcomes achieved by infringing individual liberties or by discriminating on the basis of age, sex, or race. Furthermore, there is evidence that a majority of the general public wish to give greater weight to health gains accruing to children, the severely ill, and, to a lesser extent, the socio-economically disadvantaged. This paper outlines four approaches to explicit incorporation of equity considerations into economic evaluation in public health: (i) review of background information on equity, (ii) health inequality impact assessment, (iii) analysis of the opportunity cost of equity, and (iv) equity weighting of health outcomes. The first three approaches can readily be applied using standard methods of health technology assessment, where suitable data are available; whereas approaches for generating equity weights remain experimental. The potential benefits of considering equity are likely to be largest in cases involving: (a) interventions that target disadvantaged individuals or communities and are also relatively cost-ineffective and (b) interventions to encourage lifestyle change, which may be relatively ineffective among ‘hard-to-reach’ disadvantaged groups and hence may require re-design to avoid increasing health inequalities.

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Corresponding author
*Corresponding author: Helen Weatherly, Alcuin A block, Centre for Health Economics, University of York, Heslington Road, York YO10 5DD, UK. Email: hlw4@york.ac.uk
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F.E. Alexander et al. (1999), ‘14 years of follow-up from the Edinburgh randomized trial of breast-cancer screening’, Lancet, 353(9168): 19031908.

R. Berk et al. (1985), ‘Social experimentation: a position paper’, Evaluation Review, 9: 387429.

F. Briggs , and R.M. Hawkins (1994), ‘Follow up data on the effectiveness of New Zealand’s national school based child protection programme’, Child Abuse and Neglect, 18(8): 635643.

A.J. Culyer and A. Wagstaff (1993), ‘Equity and equality in health and health care’, Journal of Health Economics, 12: 431457.

P. Dolan et al. (2003), ‘An inquiry into the different perspectives that can be used when eliciting preferences in health’, Health Economics, 12: 545551.

P. Dolan et al. (2005), ‘QALY maximisation and people's preferences: a methodological review of the literature’, Health Economics, 14(2): 197208.

C. Donaldson (1999), ‘Valuing the benefits of publicly provided health care: does “ability to pay” preclude the use of “willingness to pay”?’, Social Science and Medicine, 49: 551563.

S.J. Katz and T.P. Hofer (1994), ‘Socioeconomic disparities in preventive care persist despite universal coverage: breast and cervical cancer screening in Ontario and the United States’, Journal of the American Medical Association, 272(7): 530534.

A. Low and A. Low (2006), ‘Importance of relative measures in policy on health inequalities’, British Medical Journal, 332: 967969.

D. MacIntyre and A. Carr (1999), ‘Evaluation of the effectiveness of the stay safe primary prevention programme for child sexual abuse’, Child Abuse and Neglect, 23(12): 13071325.

E. Nord (1995), ‘The person-trade-off approach to valuing health care programs’, Medical Decision Making, 15: 201208.

R. Reading et al. (1994), ‘Do interventions that improve immunisation uptake also reduce social inequalities in uptake?’, British Medical Journal, 308: 11421144.

F. Sassi , L. Archard and J. Le Grand (2001), ‘Equity and the economic evaluation of healthcare’, Health Technology Assessment, 5(3).

P. Shackley and S. Dixon (2000), ‘Using contingent valuation to elicit public preferences for water fluoridation’, Applied Economics, 32: 777787.

P. Tugwell et al. (2006), ‘Applying clinical epidemiological methods to health equity: the equity effectiveness loop’, British Medical Journal, 332: 358361.

A. Wagstaff , P. Paci and E. van Doorslaer (1991), ‘On the measurement of inequalities in health’, Social Science and Medicine, 33: 545557.

A. Williams and R. Cookson (2000), ‘Equity in health’, in A.J. Culyer J.P. Newhouse (eds.), Handbook of Health Economics, Elsevier Science B.V.

T.H. Williamson et al. (1995), ‘Assessment of an inner city visual screening programme for preschool children’, British Journal of Opthalmology, 79(12): 10681073.

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Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
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