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Challenges and Limitations in Distributional Cost-Effectiveness Analysis: A Systematic Literature Review

Author

Listed:
  • Dirk Steijger

    (Master’s Program Global Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands)

  • Chandrima Chatterjee

    (Master’s Program Global Health, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands)

  • Wim Groot

    (Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands)

  • Milena Pavlova

    (Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands)

Abstract

Background: Cost-effectiveness is a tool to maximize health benefits and to improve efficiency in healthcare. However, efficient outcomes are not always the most equitable ones. Distributional cost-effectiveness analysis (DCEA) offers a framework for incorporating equity concerns into cost-effectiveness analysis. Objective: This systematic review aims to outline the challenges and limitations in applying DCEA in healthcare settings. Methods: We searched Medline, Scopus, BASE, APA Psych, and JSTOR databases. We also included Google Scholar. We searched for English-language peer-reviewed academic publications, while books, editorials and commentary papers were excluded. Titles and abstract screening, full-text screening, reference list reviews, and data extraction were performed by the main researcher. Another researcher checked every paper for eligibility. Details, such as study population, disease area, intervention and comparators, costs and health effects, cost-effectiveness findings, equity analysis and effects, and modelling technique, were extracted. Thematic analysis was applied, focusing on challenges, obstacles, and gaps in DCEA. Results: In total, 615 references were identified, of which 18 studies met the inclusion criteria. Most of these studies were published after 2017. DCEA studies were mainly conducted in Europe and Africa and used quality health-adjusted measurements. In the included studies, absolute inequality indices were used more frequently than relative inequality indices. Every stage of the DCEA presented challenges and/or limitations. Conclusion: This review provides an overview of the literature on the DCEA in healthcare as well as the challenges and limitations related to the different steps needed to conduct the analysis. In particular, we found problems with data availability, the relative unfamiliarity of this analysis among policymakers, and challenges in estimating differences among socioeconomic groups.

Suggested Citation

  • Dirk Steijger & Chandrima Chatterjee & Wim Groot & Milena Pavlova, 2022. "Challenges and Limitations in Distributional Cost-Effectiveness Analysis: A Systematic Literature Review," IJERPH, MDPI, vol. 20(1), pages 1-14, December.
    • Handle: RePEc:gam:jijerp:v:20:y:2022:i:1:p:505-:d:1017911
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    References listed on IDEAS

    as
    1. Miqdad Asaria & Susan Griffin & Richard Cookson, 2016. "Distributional Cost-Effectiveness Analysis," Medical Decision Making, , vol. 36(1), pages 8-19, January.
    2. James Love-Koh & Richard Cookson & Karl Claxton & Susan Griffin, 2020. "Estimating Social Variation in the Health Effects of Changes in Health Care Expenditure," Medical Decision Making, , vol. 40(2), pages 170-182, February.
    3. Stéphane Verguet & Jane J. Kim & Dean T. Jamison, 2016. "Extended Cost-Effectiveness Analysis for Health Policy Assessment: A Tutorial," PharmacoEconomics, Springer, vol. 34(9), pages 913-923, September.
    4. Susan Griffin & James Love-Koh & Becky Pennington & Lesley Owen, 2019. "Evaluation of Intervention Impact on Health Inequality for Resource Allocation," Medical Decision Making, , vol. 39(3), pages 171-182, April.
    5. Drummond, Michael F. & Sculpher, Mark J. & Torrance, George W. & O'Brien, Bernie J. & Stoddart, Greg L., 2005. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 3, number 9780198529453.
    6. Ngalesoni, Frida N. & Ruhago, George M. & Mori, Amani T. & Robberstad, Bjarne & Norheim, Ole F., 2016. "Equity impact analysis of medical approaches to cardiovascular diseases prevention in Tanzania," Social Science & Medicine, Elsevier, vol. 170(C), pages 208-217.
    7. Mark Sculpher & Karl Claxton, 2012. "Real Economics Needs to Reflect Real Decisions," PharmacoEconomics, Springer, vol. 30(2), pages 133-136, February.
    8. Thomas Ward & Ruben E. Mujica-Mota & Anne E. Spencer & Antonieta Medina-Lara, 2022. "Incorporating Equity Concerns in Cost-Effectiveness Analyses: A Systematic Literature Review," PharmacoEconomics, Springer, vol. 40(1), pages 45-64, January.
    9. Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), 2020. "Global Health Economics:Shaping Health Policy in Low- and Middle-Income Countries," World Scientific Books, World Scientific Publishing Co. Pte. Ltd., number 11045, June.
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