Aggregate Distributional Cost-Effectiveness Analysis of Health Technologies
Aggregate Distributional Cost-Effectiveness Analysis of Health Technologies
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DOI：
10.1016/j.jval.2019.03.006
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发表时间：
2019-05-01
期刊：
影响因子：
4.5
通讯作者：
Griffin, Susan
中科院分区：
文献类型：
--
作者：
Love-Koh, James;Cookson, Richard;Griffin, Susan
背景：健康不平等可以通过卫生系统资助的一系列治疗得到部分解决。然而，尽管卫生技术评估机构评估了健康效益和成本的总体平衡，但没有对健康不平等影响进行持续的定量评估。目标：使用总分布成本效益框架评估2012年至2014年NICE单一技术评估过程中推荐的技术的不平等影响。方法：关于健康益处、成本和患者人群的数据摘自NICE网站。使用观察到的目标疾病医院利用率的社会经济分布，将每种技术的收益分配给社会群体。不平等的措施和成本效益的估计进行了比较，使用健康不平等的影响平面，并结合使用社会福利indics.Results：27干预措施进行了评价。据估计，14项干预措施可提高人口健康水平并减少健康不平等，8项干预措施可降低人口健康水平并增加健康不平等，5项干预措施可提高健康水平并增加健康不平等。在后者5，社会福利分析，使用不平等厌恶参数反映高度关注的不平等，表明健康收益超过了负面的健康不平等impact.Conclusions：提出的方法提供了一种方法来估计新的健康技术的健康不平等的影响。这些方法不考虑具体技术的利用和健康惠益方面的差异，但与进行全面的分配成本效益分析相比，所需的资源和数据较少。它们可以提供有用的量化信息，帮助决策者考虑新技术可能在多大程度上减少或增加健康不平等。
Background: Health inequalities can be partially addressed through the range of treatments funded by health systems. Nevertheless, although health technology assessment agencies assess the overall balance of health benefits and costs, no quantitative assessment of health inequality impact is consistently undertaken.Objectives: To assess the inequality impact of technologies recommended under the NICE single technology appraisal process from 2012 to 2014 using an aggregate distributional cost-effectiveness framework.Methods: Data on health benefits, costs, and patient populations were extracted from the NICE website. Benefits for each technology were distributed to social groups using the observed socioeconomic distribution of hospital utilization for the targeted disease. Inequality measures and estimates of cost-effectiveness were compared using the health inequality impact plane and combined using social welfare indices.Results: Twenty-seven interventions were evaluated. Fourteen interventions were estimated to increase population health and reduce health inequality, 8 to reduce population health and increase health inequality, and 5 to increase health and increase health inequality. Among the latter 5, social welfare analysis, using inequality aversion parameters reflecting high concern for inequality, indicated that the health gain outweighs the negative health inequality impact.Conclusions: The methods proposed offer a way of estimating the health inequality impacts of new health technologies. The methods do not allow for differences in technology-specific utilization and health benefits, but require less resources and data than conducting full distributional cost-effectiveness analysis. They can provide useful quantitative information to help policy makers consider how far new technologies are likely to reduce or increase health inequalities.