Introduction: We describe a simplified distributional cost-effectiveness analysis based on aggregate data to estimate the health inequality impact of public health interventions.
Methods: We extracted data on costs, health outcomes expressed as quality-adjusted life years (QALYs), and target populations for interventions within National Institute for Health and Care Excellence (NICE) public health guidance published up to October 2016. Evidence on variation by age, gender, and index of multiple deprivation informed socioeconomic distributions of incremental QALYs, health opportunity costs, and the baseline distribution of health. Total population QALYs, summary measures of inequality, and a health equity impact plane show results by intervention and by guideline. A value for inequality aversion from a general population survey in England let us combine impacts on health inequality and total health into a single measure of intervention value.
Results: Our estimates suggest that of 134 interventions considered by NICE, 70 (52%) reduce inequality and increase health, 21 (16%) involve a tradeoff between improving health and improving health inequality, and 43 (32%) reduce health and increase health inequality. Fully implemented, the potential impact of all recommendations was 23,336,181 additional QALYs for the population of England and Wales and a reduction of the gap in quality-adjusted life expectancy between the healthiest and least healthy from 13.78 to 13.34 QALYs. The combined value of the additional health and reduction in inequality was 28,723,776 QALYs.
Discussion: Our analysis takes account of the fact that existing public health spending likely benefits the most disadvantaged. This simple method applied separately to economic evaluation produces evidence of intervention impacts on the distribution of health that is vital in determining value for money when health inequality reduction is a policy goal.
Keywords: cost-effectiveness analysis; economic evaluation; health inequality; public health.