Distributional Cost-Effectiveness Analysis: Quantifying Health Inequality Impacts and Trade-Offs

Bio: As health systems increasingly prioritize equity, researchers must move beyond standard cost-effectiveness analysis (CEA) to understand how interventions impact health inequalities between social groups. This seminar introduces Distributional Cost-Effectiveness Analysis (DCEA), a framework designed to quantify these impacts and evaluate the trade-offs between improving total health and reducing health gaps. The session will explore the "Staircase of Health Inequality Impact," examining how social variations in disease prevalence, service uptake, long-term benefits and opportunity costs influence overall health inequality impact. Using the "Equity-Efficiency Impact Plane," we will discuss how to identify "Win-Win" interventions and how to navigate scenarios where health maximisation may conflict with inequality reduction. The presentation will also provide a timely update on the 2025 NICE methods guidance, which recommends using DCEA as supplementary analysis to inform committee deliberations on health inequalities. Designed for aspiring lead investigators with a foundational understanding of research processes, this seminar offers practical insights and resources – including a web-based calculator – to help researchers integrate quantitative equity assessments into their own funding applications and HTA submissions. Presented by Professor Richard Cookson is a Professor at the Centre for Health Economics, University of York, England, and Visiting Professor at the National University of Singapore. He has helped pioneer “equity-informative” methods of policy analysis, including distributional cost-effectiveness analysis, health equity indicators for healthcare quality assurance, methods for investigating public concern for reducing health inequality, and microsimulation methods for long-term childhood policy analysis. He has worked in the UK Prime Minister’s Delivery Unit and advised various government health agencies including NICE. Key References: Asaria, M, Griffin, S and Cookson, R. (2016). "Distributional Cost-Effectiveness Analysis: A Tutorial." Medical Decision Making 36(1): 8-19. http://mdm.sagepub.com/content/36/1/8... Avanceña ALV, Prosser LA. Examining Equity Effects of Health Interventions in Cost-Effectiveness Analysis: A Systematic Review. (2021). Value in Health 24(1):136-143 https://doi.org/10.1016/j.jval.2020.1... Cookson, R., A. J. Mirelman, S. Griffin, M. Asaria, B. Dawkins, O. F. Norheim, S. Verguet and A. J. Culyer (2017). "Using Cost-Effectiveness Analysis to Address Health Equity Concerns." Value in Health 20(2): 206-212. https://doi.org/10.1016/j.jval.2016.1... Cookson, R., Kaur, G., Skarda, I., Venkatesh, S., Doran, T., Robson, M., Norheim, O, O’Donnell, O and Paulden, M (2026). The inequality-adjusted incremental cost-effectiveness ratio. Value in Health. https://www.valueinhealthjournal.com/... Griffiths, M.J.S., Cookson, R., Avanceña, A.L.V., Espinoza, M.A., Jacobsen, C.M., Sussell, J., et al. (2025). Primer on Health Equity Research in Health Economics and Outcomes Research: An ISPOR Special Interest Group Report. Value in Health, 28, 16-24. https://doi.org/10.1016/j.jval.2024.0... Robson M, Asaria M, Cookson R, Tsuchiya A, Ali S (2017) Eliciting the level of health inequality aversion in England. Health Economics 26(10): 1328–1334 http://onlinelibrary.wiley.com/doi/10...