DISTRIBUTIONAL COST-EFFECTIVENESS ANALYSIS OF HEALTH CARE PROGRAMMES - A METHODOLOGICAL CASE STUDY OF THE UK BOWEL CANCER SCREENING PROGRAMME
DISTRIBUTIONAL COST-EFFECTIVENESS ANALYSIS OF HEALTH CARE PROGRAMMES - A METHODOLOGICAL CASE STUDY OF THE UK BOWEL CANCER SCREENING PROGRAMME
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DOI：
10.1002/hec.3058
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发表时间：
2015-06-01
期刊：
影响因子：
2.1
通讯作者：
Tappenden, Paul
中科院分区：
文献类型：
--
作者：
Asaria, Miqdad;Griffin, Susan;Tappenden, Paul
本文提出了一种新的方法框架的应用，用于进行分配成本效益分析，以在评估人口健康干预措施时将健康最大化和健康不公平变化最小化的目标结合起来。 2006 年推出的国家卫生服务肠癌筛查计划预计将改善人口的平均健康状况，并加剧与贫困和种族相关的人口健康不平等——这是干预造成不平等的典型案例。我们通过研究肠癌筛查计划的两个重新设计方案来展示分配成本效益分析框架：(i) 引入增强的针对性提醒，旨在提高贫困和种族多元化社区的筛查率；(ii) 引入基本的普遍提醒，旨在提高整个人群的筛查率。我们的分析表明，普遍提醒是最大化人口健康的策略，而定向提醒是最小化健康不公平变化的筛查策略。该框架用于展示这两个目标如何相互权衡，以及替代社会价值判断如何影响对哪种策略最好的评估，包括对健康变化的哪些方面被认为不公平的判断以及对不平等厌恶的社会水平的判断。 (c) 2014 年作者。约翰·威利父子有限公司出版的《健康经济学》
This paper presents an application of a new methodological framework for undertaking distributional cost-effectiveness analysis to combine the objectives of maximising health and minimising unfair variation in health when evaluating population health interventions. The National Health Service bowel cancer screening programme introduced in 2006 is expected to improve population health on average and to worsen population health inequalities associated with deprivation and ethnicity - a classic case of intervention-generated inequality'. We demonstrate the distributional cost-effectiveness analysis framework by examining two redesign options for the bowel cancer screening programme: (i) the introduction of an enhanced targeted reminder aimed at increasing screening uptake in deprived and ethnically diverse neighbourhoods and (ii) the introduction of a basic universal reminder aimed at increasing screening uptake across the whole population. Our analysis indicates that the universal reminder is the strategy that maximises population health, while the targeted reminder is the screening strategy that minimises unfair variation in health. The framework is used to demonstrate how these two objectives can be traded off against each other, and how alternative social value judgements influence the assessment of which strategy is best, including judgements about which dimensions of health variation are considered unfair and judgements about societal levels of inequality aversion. (c) 2014 The Authors. Health Economics published by John Wiley & Sons Ltd.