CHE Seminar - Dynamic Distributional Cost-Effectiveness Analysis: Tracking Cost-Effectiveness and Health Inequality Over Time

Event details

Abstract:

Objectives: Conventional distributional cost-effectiveness analysis (DCEA) employs static frameworks reporting aggregate lifetime outcomes, obscuring how health inequality evolves as preventive interventions diffuse through populations. We develop Dynamic DCEA, extending conventional approaches by modelling inter-cohort interactions through knowledge transfer and disease risk spillover.

Methods: The framework employs a rolling multi-cohort Markov model stratified by socioeconomic subgroups, with time-varying logistic uptake functions and cohort-specific knowledge transfer. Inequality is tracked annually using Atkinson indices and equally distributed equivalent health. Application compares Dynamic DCEA against DCEA without interactions and conventional single-cohort DCEA using a hypothetical preventive intervention across 20 birth cohorts and five socioeconomic quintiles over a 20-year horizon.

Results: Dynamic DCEA generated 49% higher net monetary benefit than conventional DCEA (AUD~5,443 million versus AUD~3,640 million), transitioned to cost-saving by year~20, and revealed a qualitative reversal in equity conclusions: conventional DCEA estimated sustained inequality worsening, while Dynamic DCEA showed transition to inequality-reducing status by year~17. Three distinct equity--efficiency phases were identified.

Conclusions: Modelling framework choice can alter the direction of equity conclusions and the magnitude of cost-effectiveness estimates. Dynamic DCEA enables identification of temporal transition points for adaptive health technology assessment.

If you are not a member of University of York staff and are interested in attending a seminar, please contact richard.cookson@york.ac.uk so that we can ensure we have sufficient space.