Incorporating Equity–Efficiency Interactions in Cost-Effectiveness Analysis—Three Approaches Applied to Breast Cancer Control
Version of Record online: 31 MAR 2010
© 2010, International Society for Pharmacoeconomics and Outcomes Research (ISPOR)
Value in Health
Volume 13, Issue 5, pages 573–579, August 2010
How to Cite
Baeten, S. A., Baltussen, R. M. P. M., Uyl-de Groot, C. A., Bridges, J. and Niessen, L. W. (2010), Incorporating Equity–Efficiency Interactions in Cost-Effectiveness Analysis—Three Approaches Applied to Breast Cancer Control. Value in Health, 13: 573–579. doi: 10.1111/j.1524-4733.2010.00718.x
- Issue online: 5 AUG 2010
- Version of Record online: 31 MAR 2010
- breast cancer;
- equity–efficiency trade-off;
- health economics methods;
- Markov model
Background: The past decade, medical technology assessment focused on cost-effectiveness analysis, yet there is an increasing need to consider equity implications of health interventions as well. This article addresses three equity–efficiency trade-off methods proposed in the literature. Moreover, it demonstrates their impact on cost-effectiveness analyses in current breast cancer control options for women of different age groups.
Methods: We adapted an existing breast cancer model to estimate cost-effectiveness and equity effects of breast cancer interventions. We applied three methods to quantify the equity–efficiency trade-offs: 1) targeting specific groups, comparing disparities at baseline and in different intervention scenarios; 2) equity weighting, valuing low and high health gains differently; and 3) multicriteria decision analysis, weighing multiple equity and efficiency criteria. We compared the resulting composite league tables of all approaches.
Results: The approaches show that a comprehensive breast cancer program, including screening, for women below 75 years of age was most attractive in both the group targeting approach and the equity weighting approach. Such control programs would reduce disparities with 56% and at €1908 per equity quality-adjusted life-year gained. In the multicriteria approach, a comprehensive treatment program for women below 75 years of age and treatment in stage III breast cancer were most attractive, with both an 82% selection probability, followed by screening programs for the two age groups.
Conclusion: In the three equity weighing approaches, targeting women below 75 years of age was more cost-effective and led to more equitable distributions of health. This likely is similar in other fatal diseases with similar age distributions. The approaches may lead to different outcomes in nonfatal disease.