Standard cost-effectiveness analysis (CEA) focuses on efficiency in terms of improving overall population health. However, decision makers may be concerned with reducing health inequality as well as improving health. This study aims to develop an analytical framework for quantifying concerns about health inequality within cost-effectiveness analysis of health sector programmes. Concern for health inequality may depend upon contestable beliefs and evidence about multiple and complex influences on health inequality, including the role of health care and public health interventions, as well as contestable value judgements about equity or fairness. The purpose of the framework is to provide decision makers and stakeholders with information about their health inequality concerns within the context of a deliberative decision making process, rather than to impose any particular scientific or social value judgements about health inequality.
This study will explore options for how CEA can be extended appropriately and quantitatively to incorporate concerns for inequality. Drawing on the literature for measuring inequalities in, and the determinants of, health it will identify the range of existing approaches that could be applied within CEA by examining their quantitative properties, practicality and underlying normative principles. The results will provide guidance on the alternative methods at each stage of the CEA of health care programmes for a decision maker concerned with both efficiency and inequality. Stylised examples and methodological case studies will illustrate the approach from the perspective of a UK decision maker.
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