Should health technology assessment (HTA) processes consider using distributional cost effectiveness analysis (DCEA) to incorporate technology impacts on inequality?\u00a0 Some say \u2018yes\u2019 and some say \u2018no\u2019. Let\u2019s take a look at both sides. <\/p>\n
No<\/strong><\/p>\n In a \u201cThe NICE technical team clarified that NICE\u2019s position is that the NICE health technology evaluations manual<\/a>\u00a0does not allow for a quantitative modifier for health inequalities. NICE does not consider that there is sufficiently robust evidence to support using aversion weights as part of a DCEA. But, taken together, the NICE health technology evaluations manual, statutory duties, principles and deliberative decision making provide the flexibility to take into account relevant considerations.\u201d<\/p>\n One reason is that it is known known with certainty how much A second issue is over which groups should inequality Ramagopalan also notes that in the US, the Institute for Yes<\/strong><\/p>\n A ViH <\/em>letter to the editor by Koh, Murray, Brooke, Owen and Shah (2025)<\/a> responds to Ramagopalan and argues that, yes, DCEA should be included in HTA.\u00a0 Koh and colleagues state that NICE has long considered health disparities and inequities in their evaluations, just more frequently from a qualitative\u2014rather than quantitative\u2014perspective. The authors cite recent NICE guidelines on how to address health inequalities in breast cancer (Slade et al. 2024<\/a>)\u00a0 NICE guidelines (NG246<\/a>) also states that:<\/p>\n \u201c\u2026local commissioners and providers of healthcare have a responsibility\u2026to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities\u201d<\/p>\n In fact, in May 2024, NICE updated their methods around While Koh and co-authors do argue that there is some good The debate<\/strong><\/p>\n So which side do you take?\u00a0<\/p>","protected":false},"excerpt":{"rendered":" Should health technology assessment (HTA) processes consider using distributional cost effectiveness analysis (DCEA) to incorporate technology impacts on inequality?\u00a0 Some say \u2018yes\u2019 and some say \u2018no\u2019. Let\u2019s take a look at both sides. No In a Letter to the Editor in Value in Health, Sreeram Ramagopalan noted that NICE currently has a number of concerns…<\/p>\n","protected":false},"author":0,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[],"class_list":["post-8427","post","type-post","status-publish","format-standard","hentry","category-articles"],"_links":{"self":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/8427"}],"collection":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"replies":[{"embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=8427"}],"version-history":[{"count":0,"href":"https:\/\/medical-article.com\/index.php?rest_route=\/wp\/v2\/posts\/8427\/revisions"}],"wp:attachment":[{"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=8427"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=8427"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medical-article.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=8427"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
\nLetter to the Editor in Value in Health<\/em>, Sreeram Ramagopalan<\/a> noted
\nthat NICE currently has a number of concerns with potentially implementing
\ndistributional cost effectiveness analysis (DCEA) as part of decisions
\nmaking.\u00a0 Ramagopalan writes:<\/p>\n
\npeople actually are willing to trade of health gains to the average person in
\norder to reduce inequality.\u00a0 The most
\ncommonly used inequality aversion parameter used in the literature is 11
\n(Atkinson relative inequality aversion index) from Robson et al. 2017<\/a>; however, NICE\u2019s
\nexternal assessment group (EAG) preferred to use a value of\u00a03.5, taken
\nfrom a more recent estimate (Robson et\u00a0al. 2024<\/a>)<\/p>\n
\naversion be reduced?\u00a0 Race? Geography?
\nIncome?\u00a0 They note inequality over
\ndifferent racial groups is highly relevant for beta thalassemia, but for an
\nevaluation of exagamglogene autotemcel (TA1033<\/a>)
\nquintiles of the index of multiple deprivation (IMD) were used as a proxy for
\nrace\/ethnicity. NICE\u2019s EAG noted in their review that IMD was a highlight
\nimperfect proxy for ethnicity-specific quality-adjusted life expectancy (QALE)
\ndata.<\/p>\n
\nClinical and Economic Review (ICER) has not adopted DCEA [see ICER
\nwhite paper<\/a>]. \u00a0While there are
\nestimates of quality adjusted life expectancy in the US (Kowal et al. 2023<\/a>) and the
\nUK (Love-Koh et al. 2015<\/a>)<\/p>\n
\nhealth inequalities (Hughes
\n2025<\/a>, PMG36<\/a>)
\nand have published a methods support document on DCEA usage which includes stratification
\nof social groups, uncertainty, health opportunity cost and reporting outputs (NICE
\nimplementation support, 13 May 2025<\/a>). <\/p>\n
\nevidence on inequality aversion preferences, they admit that there is no
\nconsensus on the exact degree of this trade-off as well as no precise process
\nin terms of how DCEA should be operationalized. Additionally, DCEAs are more complex
\nto implement that traditional CEA. The authors agree that a DCEA is not needed
\nfor every intervention; however, when new health technologies can materially
\nimpact health disparities\u2014for the positive or the negative\u2014DCEA is a useful
\ntool for HTA bodies can use to help inform their decisionmaking. <\/p>\n