Distributional Cost-Effectiveness Analysis of Health Care Programmes – A Methodological Case Study of the UK Bowel Cancer Screening Programme
Article first published online: 2 MAY 2014
© 2014 The Authors. Health Economics published by John Wiley & Sons Ltd.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Volume 24, Issue 6, pages 742–754, June 2015
How to Cite
2015), Distributional Cost-Effectiveness Analysis of Health Care Programmes – A Methodological Case Study of the UK Bowel Cancer Screening Programme. Health Econ., 24, 742–754. doi: 10.1002/hec.3058., , , , and (
- Issue published online: 17 APR 2015
- Article first published online: 2 MAY 2014
- Manuscript Accepted: 1 APR 2014
- Manuscript Revised: 6 MAR 2014
- Manuscript Received: 22 OCT 2013
- Department of Health
- health inequality;
- cost-effectiveness analysis
This paper presents an application of a new methodological framework for undertaking distributional cost-effectiveness analysis to combine the objectives of maximising health and minimising unfair variation in health when evaluating population health interventions. The National Health Service bowel cancer screening programme introduced in 2006 is expected to improve population health on average and to worsen population health inequalities associated with deprivation and ethnicity – a classic case of ‘intervention-generated inequality’. We demonstrate the distributional cost-effectiveness analysis framework by examining two redesign options for the bowel cancer screening programme: (i) the introduction of an enhanced targeted reminder aimed at increasing screening uptake in deprived and ethnically diverse neighbourhoods and (ii) the introduction of a basic universal reminder aimed at increasing screening uptake across the whole population. Our analysis indicates that the universal reminder is the strategy that maximises population health, while the targeted reminder is the screening strategy that minimises unfair variation in health. The framework is used to demonstrate how these two objectives can be traded off against each other, and how alternative social value judgements influence the assessment of which strategy is best, including judgements about which dimensions of health variation are considered unfair and judgements about societal levels of inequality aversion. © 2014 The Authors. Health Economics published by John Wiley & Sons Ltd.