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The 5th ELSI Congress - ELSIcon2022

ELSIcon2022 Flash: Distributional Cost-Effectiveness Analysis to Incorporate Health Equity Concerns in the Assessment of the Value of Precision Medicine Technologies


ELSIcon2022 • Flash • May 31, 2022

Cheng Chen, Jeroen Jansen

BACKGROUND: Distributional cost-effectiveness analysis (DCEA) has been recently proposed as an intuitive extension of conventional cost-effectiveness analysis to examine health equity impacts of health care interventions. A DCEA provides relevant information for policy-makers that not only aim to improve total health but are concerned about inequality in health outcomes as well. However, the use of DCEA has been limited, especially in the context of precision medicine.

OBJECTIVE: To illustrate DCEA with an example evaluation of the use of liquid biopsy to inform first-line targeted therapy for advanced non-small cell lung cancer (NSCLC).

METHODS: We developed a decision model to compare expected outcomes and costs for the scenarios with and without liquid biopsy based on currently available evidence. The distributions of the modeled health outcomes, taking into consideration the opportunity costs, were compared in terms of average health and health inequality across different social subgroups of interest. 

RESULTS: Our evaluation showed for which clinical scenarios the use of liquid biopsy to inform treatment decisions has value and whether baseline disparities in NSCLC outcomes are likely to be reduced or exacerbated. The analysis also highlighted a primary challenge with a DCEA of a new technology: gaps in the evidence base regarding test performance and treatment effects in minority populations.

CONCLUSIONS: Despite uncertainty in the estimated health equity impact of a new health technology due to gaps in the evidence base, pursuing a DCEA is worthwhile as it contributes to more honest policy discussions regarding health equity in relation to precision medicine.


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