Distributional Cost-Effectiveness Analysis: A Tutorial

Distributional cost-effectiveness analysis (DCEA) is a framework for incorporating health inequality concerns into the economic evaluation of health sector interven-tions. In this tutorial, we describe the technical details of how to conduct DCEA, using an illustrative example com-paring alternative ways of implementing the National Health Service (NHS) Bowel Cancer Screening Programme (BCSP). The 2 key stages in DCEA are 1) modeling social distributions of health associated with different interven-tions, and 2) evaluating social distributions of health with respect to the dual objectives of improving total population health and reducing unfair health inequality. As well as describing the technical methods used, we also identify the data requirements and the social value judgments that have to be made. Finally, we demonstrate the use of sensitivity analyses to explore the impacts of alternative modeling assumptions and social value judgments. Key words: cost-effectiveness analysis; economic evaluation; efficiency; equality; equity; fairness; health distribution; health inequality; inequality measures; opportunity cost; social value judgments; social welfare functions; tradeoff. (Med Decis Making XXXX;XX:XXX–XXX