OBJECTIVES: Inequalities in breast cancer exist by deprivation (mortality) and ethnicity (incidence and mortality). Recent NICE appraisals have highlighted inequalities in breast cancer according to ethnicity but have not quantified these. Distributional cost-effectiveness analysis (DCEA) evaluates the cost-effectiveness of health interventions within different demographic groups. A key data requirement of DCEA is quality-adjusted life expectancy (QALE) by subgroup; these data are currently unavailable by ethnicity in the UK. This study therefore aimed to conduct an aggregate DCEA in breast cancer with Index of Multiple Deprivation (IMD) as the domain of equity.

METHODS: Published data enabled the development of an aggregate DCEA, requiring stratified incidence data only, with IMD as equity subgroup. Population subgroups, baseline health distributions and opportunity costs were defined by IMD quintile. Representative incremental costs and quality-adjusted life years (QALYs) for a hypothetical treatment in breast cancer were used. The Atkinson social welfare function quantified trade-offs between health maximization and equity.

RESULTS: At a £30,000/QALY threshold and an Atkinson parameter of 10.95, the incremental population net health benefit was 15.8 QALYs, and the incremental Equal Distribution Equivalent Health (EDEH) was 4.2, suggesting an improvement in population health, but a worsening of health inequalities according to IMD.

CONCLUSIONS: This study highlights challenges in quantifying how new technologies may impact health inequalities in the UK. There are known inequalities according to ethnicity in breast cancer, however, we were unable to assess that inequality due to data insufficiency, and a DCEA in breast cancer found potentially worsening inequalities by IMD. There is a need for better data across all domains of equity, particularly those with published inequalities in unmet need such as ethnicity. This would enable a better assessment of treatment impact on inequalities to inform healthcare investment. A full DCEA, considering inequalities in both incidence and mortality, would provide a more comprehensive assessment.