Accounting for Equity in Health Technology Assessment

PURPOSE:

To present extensions of the conventional cost-effectiveness framework, including multiple criteria decision analysis (MCDA) and distributional cost-effectiveness analysis (DCEA), that are capable of quantitatively assessing the impact of a healthcare treatment on equity. For each method, the implementation complexity, data requirements, integration with cost-effectiveness and budget impact estimates, and the ability to measure change in the inequality distribution will be presented.

DESCRIPTION:

Traditional methods for economic evaluation are criticized because they are focused on efficiency and affordability, while other factors such as equity are important attributes to decision making. Equity is traditionally incorporated in health technology assessments (HTA) through committee deliberations, but this approach has also been criticized as lacking rigor and transparency. Melanie Whittington (10 minutes) will introduce the workshop by presenting the results of the Institute for Clinical and Economic Review’s recent health equity initiative, including findings from a literature review and interviews with experts related to equity-informative economic evaluation. Brett McQueen (15 minutes) will provide an overview of how MCDA can be used to incorporate equity into a value assessment, with an in-depth discussion of the potential use of MCDA to inform structured deliberation. He will include an interactive exercise to demonstrate how additional criteria can be explicitly included in value assessment deliberations. Stacey Kowal (15 minutes) will provide an overview of how DCEA can be used to incorporate equity in a value assessment, with an in-depth discussion of data and stakeholder-alignment needed to support DCEA. Her session will include audience polling about the range of use cases for DCEA, including informing the equity impact of funding decisions and decision-making about patient access. Adequate time (20 minutes) for audience questions and comments will be reserved. This workshop will be relevant for a range of stakeholders, including health economists, HTA groups, life science companies, patients, and decision makers.