1
|
Steijger D, Chatterjee C, Groot W, Pavlova M. Challenges and Limitations in Distributional Cost-Effectiveness Analysis: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:505. [PMID: 36612824 PMCID: PMC9819735 DOI: 10.3390/ijerph20010505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/15/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
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.
Collapse
Affiliation(s)
- 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
| |
Collapse
|
2
|
Tian W, Wu B, Yang Y, Lai Y, Miao W, Zhang X, Zhang C, Xia Q, Shan L, Yang H, Yang H, Huang Z, Li Y, Zhang Y, Ding F, Tian Y, Li H, Liu X, Li Y, Wu Q. Degree of protection provided by poverty alleviation policies for the middle-aged and older in China: evaluation of effectiveness of medical insurance system tools and vulnerable target recognition. Health Res Policy Syst 2022; 20:129. [DOI: 10.1186/s12961-022-00929-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/12/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
China’s medical insurance schemes and poverty alleviation policy at this stage have achieved population-wide coverage and the system's universal function. At the late stage of the elimination of absolute poverty task, how to further exert the poverty alleviation function of the medical insurance schemes has become an important agenda for targeted poverty alleviation. To analyse the risk of catastrophic health expenditure (CHE) occurrence in middle-aged and older adults with vulnerability characteristics from the perspectives of social, regional, disease, health service utilization and medical insurance schemes.
Methods
We used data from the 2018 China Health and Retirement Longitudinal Study (CHARLS) database and came up with 9190 samples. The method for calculating the CHE was adopted from WHO. Logistic regression was used to determine the different characteristics of middle-aged and older adults with a high probability of incurring CHE.
Results
The overall regional poverty rate and incidence of CHE were similar in the east, central and west, but with significant differences among provinces. The population insured by the urban and rural integrated medical insurance (URRMI) had the highest incidence of CHE (21.17%) and health expenditure burden (22.77%) among the insured population. Integration of Medicare as a medical insurance scheme with broader benefit coverage did not have a significant effect on the incidence of CHE in middle-aged and older people with vulnerability characteristics.
Conclusions
Based on the perspective of Medicare improvement, we conducted an in-depth exploration of the synergistic effect of medical insurance and the poverty alleviation system in reducing poverty, and we hope that through comprehensive strategic adjustments and multidimensional system cooperation, we can lift the vulnerable middle-aged and older adults out of poverty.
Collapse
|
3
|
Ward T, Mujica-Mota RE, Spencer AE, Medina-Lara A. Incorporating Equity Concerns in Cost-Effectiveness Analyses: A Systematic Literature Review. PHARMACOECONOMICS 2022; 40:45-64. [PMID: 34713423 DOI: 10.1007/s40273-021-01094-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The aim of this study was to review analytical methods that enable the incorporation of equity concerns within economic evaluation. METHODS A systematic search of PubMed, Embase, and EconLit was undertaken from database inception to February 2021. The search was designed to identify methodological approaches currently employed to evaluate health-related equity impacts in economic evaluation studies of healthcare interventions. Studies were eligible if they described or elaborated on a formal quantitative method used to integrate equity concerns within economic evaluation studies. Cost-utility, cost-effectiveness, cost-benefit, cost-minimisation, and cost-consequence analyses, as well as health technology appraisals, budget impact analyses, and any relevant literature reviews were included. For each of the identified methods, we provided summaries of the scope of equity considerations covered, the methods employed and their key attributes, data requirements, outcomes, and strengths and weaknesses. A traffic light assessment of the practical suitability of each method was undertaken, alongside a worked example applying the different methods to evaluate the same decision problem. Finally, the review summarises the typical trade-offs arising in cost-effectiveness analyses and discusses the extent to which the evaluation methods are able to capture these. RESULTS In total, 68 studies were included in the review. Methods could broadly be grouped into equity-based weighting (EBW) methods, extended cost-effectiveness analysis (ECEA), distributional cost-effectiveness analysis (DCEA), multi-criteria decision analysis (MCDA), and mathematical programming (MP). EBW and MP methods enable equity consideration through adjustment to incremental cost-effectiveness ratios, whereas equity considerations are represented through financial risk protection (FRP) outcomes in ECEA, social welfare functions (SWFs) in DCEA, and scoring/ranking systems in MCDA. The review identified potential concerns for EBW methods and MCDA with respect to data availability and for EBW methods and MP with respect to explicitly measuring changes in inequality. The only potential concern for ECEA related to the use of FRP metrics, which may not be relevant for all healthcare systems. In contrast, DCEA presented no significant concerns but relies on the use of SWFs, which may be unfamiliar to some audiences and requires societal preference elicitation. Consideration of typical cost-effectiveness and equity-related trade-offs highlighted the flexibility of most methods with respect to their ability to capture such trade-offs. Notable exceptions were trade-offs between quality of life and length of life, for which we found DCEA and ECEA unsuitable, and the assessment of lost opportunity costs, for which we found only DCEA and MP to be suitable. The worked example demonstrated that each method is designed with fundamentally different analytical objectives in mind. CONCLUSIONS The review emphasises that some approaches are better suited to particular decision problems than others, that methods are subject to different practical requirements, and that significantly different conclusions can be observed depending on the choice of method and the assumptions made. Further, to fully operationalise these frameworks, there remains a need to develop consensus over the motivation for equity assessment, which should necessarily be informed with stakeholder involvement. Future research of this topic should be a priority, particularly within the context of equity evaluation in healthcare policy decisions.
Collapse
Affiliation(s)
- Thomas Ward
- Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, UK.
- College of Medicine and Health, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK.
| | - Ruben E Mujica-Mota
- Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, UK
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, UK
| | - Anne E Spencer
- Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, UK
| | - Antonieta Medina-Lara
- Health Economics Group, College of Medicine and Health, University of Exeter, Exeter, UK
| |
Collapse
|
4
|
Ma M, Tian W, Kang J, Li Y, Xia Q, Wang N, Miao W, Zhang X, Zhang Y, Shi B, Gao H, Sun T, Fu X, Hao Y, Li H, Shan L, Wu Q, Li Y. Does the medical insurance system play a real role in reducing catastrophic economic burden in elderly patients with cardiovascular disease in China? Implication for accurately targeting vulnerable characteristics. Global Health 2021; 17:36. [PMID: 33781274 PMCID: PMC8006647 DOI: 10.1186/s12992-021-00683-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The vulnerability of cardiovascular disease (CVD) patients' health abilities, combined with the severity of the disease and the overlapping risk factors, leads such people to bear the economic burden of the disease due to the medical services. We estimated the economic burden of CVD and identified the weak link in the design of the medical insurance. METHODS Data from 5610 middle-aged and elderly with CVD were drawn from the 2015 wave of "China Health and Retirement Longitudinal Study" (CHARLS). The recommended method of the "World Health Organization" (WHO) was adopted to calculate "catastrophic health expenditure" (CHE), "impoverishment by medical expenses" (IME), and applied the treatment-effect model to analyze the determinants of CHE. RESULTS The incidence of CHE was 19.9% for the elderly families with CVD members, which was 3.6% higher than for uninsured families (16.3%). Families with CVD combined with > 3 other chronic diseases (38.88%) were the riskiest factor for the high CHE in the new rural cooperative medical system (NCMS). Moreover, families with members > 75 years old (33.33%), having two chronic disease (30.74%), and families having disabled members (33.33%), hospitalization members (32.41%) were identified as the high risky determinants for the high CHE in NCMS. CONCLUSIONS Elderly with physical vulnerabilities were more prone to CHE. The medical insurance only reduced barriers to accessing health resources for elderly with CVD; however it lacked the policy inclination for high-utilization populations, and had poorly accurate identification of the vulnerable characteristics of CVD, which in turn affects the economic protection ability of the medical insurance. The dispersion between the multiple medical security schemes leads to the existence of blind spots in the economic risk protection of individuals and families.
Collapse
Affiliation(s)
- Meiyan Ma
- Research Center of Public Policy and Management, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Wanxin Tian
- Research Center of Public Policy and Management, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Jian Kang
- Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China
| | - Yuze Li
- Department of Medicine, Jiamusi University, Jiamusi, 154007, Heilongjiang, China
| | - Qi Xia
- Research Center of Public Policy and Management, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Nianshi Wang
- Research Center of Public Policy and Management, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Wenqing Miao
- Research Center of Public Policy and Management, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Xiyu Zhang
- Research Center of Public Policy and Management, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Yiyun Zhang
- School of Ethnology and Sociology, Yunnan University, Kunming, Yunnan, China
| | - Baoguo Shi
- Department of Economics, School of Economics, Minzu University of China, Beijing, China
| | - Han Gao
- The Affiliated Tumor Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tao Sun
- Department of Health Service Management, School of Medicine, Hang Zhou Normal University, Hangzhou, Zhejiang, China
| | - Xuelian Fu
- The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yanhua Hao
- Research Center of Public Policy and Management, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China
| | - Heng Li
- Hospital Development institute of Shanghai Jiao Tong University, Shanghai, China
| | - Linghan Shan
- Research Center of Public Policy and Management, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.
| | - Qunhong Wu
- Research Center of Public Policy and Management, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.
| | - Ye Li
- Research Center of Public Policy and Management, School of Health Management, Harbin Medical University, Harbin, 150086, Heilongjiang, China.
| |
Collapse
|
5
|
Dawkins BR, Mirelman AJ, Asaria M, Johansson KA, Cookson RA. Distributional cost-effectiveness analysis in low- and middle-income countries: illustrative example of rotavirus vaccination in Ethiopia. Health Policy Plan 2018; 33:456-463. [DOI: 10.1093/heapol/czx175] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bryony R Dawkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, Worsley Building, Clarendon Way, Leeds LS2 9NL, UK,
| | - Andrew J Mirelman
- Centre for Health Economics, Alcuin 'A' Block, University of York, Heslington YO10 5DD, United Kingdom,
| | - Miqdad Asaria
- Centre for Health Economics, Alcuin 'A' Block, University of York, Heslington YO10 5DD, United Kingdom,
| | - Kjell Arne Johansson
- Department of Global Public Health and Primary Care, University of Bergen Postboks 7804, N-5020 Bergen, Norway and
- Department of Addiction Medicine, Haukeland University Hospital, Kalfarveien 31, 5020 Bergen, Norway
| | - Richard A Cookson
- Centre for Health Economics, Alcuin 'A' Block, University of York, Heslington YO10 5DD, United Kingdom,
| |
Collapse
|
6
|
Coast J. A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967-2017. Soc Sci Med 2017; 196:227-232. [PMID: 29132835 DOI: 10.1016/j.socscimed.2017.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 10/16/2017] [Accepted: 10/30/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Joanna Coast
- Population Health Sciences, Bristol Medical School, University of Bristol, United Kingdom.
| |
Collapse
|