SASSI F, ARCHARD L, LE GRAND J; International Society of Technology Assessment in Health Care. Meeting.

Annu Meet Int Soc Technol Assess Health Care Int Soc Technol Assess Health Care Meet. 2001; 17: abstract no. 216.

Department of Social Policy, London School of Economics, London, UK

Introduction - Methods commonly used to assess health technologies often ignore distributional effects. Despite recent attempts to add an equity dimension to cost-effectiveness studies, mainly by applying equity weights to health outcomes, decisions about the adoption and use of technologies with potential equity implications are still based more on value judgements than on a sound evidence base.We studied three technologies with potential equity implications: cervical cancer screening (equity dimension = socio-economic differentials in incidence and uptake); renal transplantation (age of organ recipients); and sickle cell screening (race differentials in incidence). The aim was to determine whether there are any equity-efficiency tradeoffs and what equity principles have guided the development of policies for the use of the technologies in the UK.Methods - We reviewed systematically and examined the effectiveness and cost-effectiveness evidence available (when the latter was not available ad hoc economic analyses were undertaken). Policies adopted in the UK and their effects were examined on the basis of published documentation.Results - All three case studies show that there are important tradeoffs between equity and efficiency and indicate patterns in the way policy makers address such tradeoffs in the absence of explicit evidence about distributional effects. Policy makers seem to be primarily concerned with equity of access, rather than outcomes, whereby access is simplistically viewed as a supply-side issue (i.e. availability). Equity of access is so highly valued as a policy goal that sacrifices are accepted on effectiveness (cervical cancer screening), or cost-effectiveness (sickle cell screening), grounds. The case of renal transplantation, in which equity of access is not an option due to a scarcity of organs, shows that the values implied by existing policies are not consistent with those elicited by population surveys with regard to prioritising health services by age, and have a high cost in terms of efficiency.

Publication Types:

• Meeting Abstracts

Keywords:

• Cost-Benefit Analysis
• Data Collection
• Health Services
• Health Services Accessibility
• Health Services Research
• Mass Screening
• economics
• hsrmtgs

Other ID:

• GWHSR0002869

UI: 102274548

From Meeting Abstracts