Distributional cost-effectiveness analysis (DCEA)
Equity impact plane
Introductory resources
For professionals
- NIHR Webinar and Infographic: Distributional Cost-Effectiveness Analysis (May 2026)
- Primer on health equity research - ISPOR Special Interest Group Report 2025
- Using cost-effectiveness analysis to address health equity concerns - Value in Health 2017
- Distributional Cost-Effectiveness Analysis Comes of Age – Editorial in Value in Health 2021
- iHEA Webinar: Methods for Incorporating Equity into Economic Evaluation (June 2020)
- Blog: Distributional Cost Effectiveness Analysis (September 2018)
For the public
- Learning about economic evaluation and health inequality (PDF
, 1,060kb) - Conducting DCEA using aggregate data (PDF , 279kb)
- Why do we need to do economic evaluations? (PDF , 1,193kb): Infographic based on the projects funded by the public health research consortium.
Technical training resources
Handbook
- Oxford University Press handbook of distributional cost-effectiveness analysis, and online spreadsheet training exercises accompanying the handbook
Simple DCEA calculator
- Web calculator
- Technical manual: CHE RP 193, Quantifying Impact on Health Inequality in England
Institution-specific DCEA guidance
- NICE support document on health inequalities, accompanying the NICE technology appraisal and highly specialised technologies guidance manual (PMG36, last updated 31 March 2026)
Journal articles: tutorials and overviews
- Using Cost-Effectiveness Analysis to Address Health Equity Concerns. Value in Health 2017
- Distributional Cost-Effectiveness Analysis: A Tutorial. Medical Decision Making 2015
- Extended Cost-Effectiveness Analysis for Health Policy Assessment: A Tutorial. PharmacoEconomics 2016
- Primer on Health Equity Research in Health Economics and Outcomes Research: An ISPOR Special Interest Group Report. Value in Health 2025
Supplementary readings
DCEA methods
Basic
- Distributional Cost-Effectiveness Analysis of Health Care Programmes: A Methodological Case Study of the UK Bowel Cancer Screening Programme. Health Economics 2014
- Aggregate Distributional Cost-Effectiveness Analysis of Health Technologies. Value in Health 2019
- Evaluation of Intervention Impact on Health Inequality for Resource Allocation. Medical Decision Making 2019
Advanced/specialised
- Themed section: Health Equity - Methods and Measures for Equity Informative Evaluations. Value in Health, June 2026 (collection of current methods research)
- Impact of Socioeconomic Differences on Distributional Cost-Effectiveness Analysis. Medical Decision Making 2020
Headline metrics of health inequality impact and trade-offs
Basic
- Chapter 4: Describing Equity Impacts and Trade-Offs. Oxford University Press Handbook of DCEA 2020
- How big is the health inequality impact of a new treatment, and how much is it worth? CHE Research Summary 2026
- A Method for Comparing Health Inequality Impact Magnitudes, with an Illustration for Hypothetical Treatments of 1336 Diseases. PharmacoEconomics 2026
- The Inequality-Adjusted Incremental Cost-Effectiveness Ratio. Value in Health 2026
Advanced/specialised
- A Threshold Inequality Aversion Parameter Approach to Interpret Distributional Cost-Effectiveness Analysis Results. Value in Health 2026
Baseline social distribution of health
Basic
- Decomposition of Quality-Adjusted Life Expectancy Inequalities by Mortality and Health-Related Quality of Life Dimensions. PharmacoEconomics 2023
- The Apparent Discrepancy Between Social Inequality in Disability-Free and Quality-Adjusted Life Expectancy Value in Health 2026
Advanced/specialised
- Appropriate Categorization of Inequality to Inform Policy Decisions: Estimating Distribution of Lifetime Health Using Alternative Approaches to Socioeconomic Stratification. Value in Health 2024
Health inequality aversion
Basic
- Strengthening Methods and International Evidence on Health Inequality Aversion. Value in Health 2026
- Eliciting the Level of Health Inequality Aversion in England. Health Economics 2017
- Adapting a Benefit Trade-Off Instrument to Measure Health Inequality Aversion in the United States. Value in Health Regional Issues 2026
- Health Inequality Aversion in the United States. Value in Health 2025
- Public Preferences for Reducing Health Inequality in Japan: A National Survey. Value in Health Regional Issues 2025
Advanced/specialised
- Health inequality aversion in China: Public and decision-maker views Social Science and Medicine 2026
- Aversion to Health Inequality: Pure, Income-Related and Income-Caused. Journal of Health Economics 2024
- An experimental investigation of social risk preferences for health. Theory and Decision 2023
Health opportunity cost
Basic
- Do the Poor Gain More? The Impact of Secondary-Care Expenditure on Health Inequality. Applied Health Economics and Health Policy 2026
- Interpreting contrasting evidence on the distribution of health effects of NHS spending for policy purposes. Economic Evaluation Policy Research Unit Report 2026
- Estimating Social Variation in the Health Effects of Changes in Health Care Expenditure. Medical Decision Making 2020
International perspectives
Basic
Networking resources
- ISPOR Special Interest Group in Health Equity Research
- iHEA Special Interest Group on Equity-Informative Economic Evaluation
Key institutions relevant to DCEA
- Harvard Extended Cost-Effectiveness Analysis (ECEA)
- Bergen Centre for Ethics and Priority Setting (BCEPS)
Modelling groups relevant to DCEA
Old resources
Online distributional cost-effectiveness analysis tool
Reports and working papers
- Identifying Appropriate Methods to Incorporate Concerns About Health Inequalities into Economic Evaluations of Health Care Programmes. Final Report
Book chapters
- Incorporating health inequality impacts into cost-effectiveness analysis (PDF , 330kb), in the Elsevier On-line Encyclopedia of Health Economics, 2014
- Measuring health inequality in the context of cost-effectiveness analysis (PDF , 700kb), in Health and Inequality (Research on Economic Inequality, Volume 21), 2013
Policy workshops
- Workshop 1 in March 2012 (overview)
- Workshop 2 in February 2013 (bowel cancer screening case study)
MSc workshops
These presentation materials are copyright University of York and may not be reproduced without prior permission. However, we are happy for you to re-use them for non-commercial educational or research purposes so long as you acknowledge the authors and let us know.
- MSc Workshop Feb 2019
- MSc Workshop Feb 2018
, 24kb)
, 87kb)Presentations
- Quantifying Health Equity Impacts in Effectiveness and Cost-Effectiveness Studies. Society for Social Medicine Annual Meeting (September 2016): Equity workshop at Society for Social Medicine Sep 2016 (PDF , 1,363kb)
- Incorporating Health Inequality Impacts into Cost-Effectiveness Analysis - A Framework (2016): Cookson on DCEA (PDF , 1,089kb)