Distributional cost-effectiveness analysis (DCEA)

For professionals

• 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.

Handbook

• Oxford University Press handbook of distributional cost-effectiveness analysis, and online spreadsheet training exercises, accompanying the handbook

Simple DEA calculator

• Web calculator
• Technical manual - CHE RP 193, Quantifying Impact on Health Inequality in England, Richard Cookson and James Koh

Journal articles

• Distributional Cost-Effectiveness Analysis: A Tutorial. Medical Decision Making 2015
• Extended Cost-Effectiveness Analysis for Health Policy Assessment: A Tutorial. PharmacoEconomics 2016
• Evaluation of Intervention Impact on Health Inequality for Resource Allocation. Medical Decision Making 2019 

DCEA Methods

• 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
• Impact of Socioeconomic Differences on Distributional Cost-Effectiveness Analysis. Medical Decision Making 2020 
• Methods to Promote Equity in Health Resource Allocation in Low- And Middle-Income Countries: An Overview. Globalization and Health 2020 

Baseline social distribution of health

• Decomposition of Quality-Adjusted Life Expectancy Inequalities by Mortality and Health-Related Quality of Life Dimensions. PharmacoEconomics 2023
• 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

• Strengthening methods and international evidence on health inequality aversion. Value in Health  2026 (forthcoming)
• Eliciting the Level of Health Inequality Aversion in England. Health Economics 2017
• 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
• Do the Poor Gain More? The Impact of Secondary Care Expenditure on Health Inequality. Applied Health Economics and Health Policy 2026 

Standard measure of health inequality impact

A method for comparing health inequality impact magnitudes, with an illustration for hypothetical treatments of 1,336 diseases. PharmacoEconomics 2026 

Chapter 4: Describing equity impacts and trade-offs. Oxford University Press Handbook of DCEA 2020

• 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

• Sheffield Addictions Research Group (SARG)

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 2019: Instructions (MS Word , 24kb)
  • MSc Workshop Feb 2019: Dominance analysis - student (MS Excel , 87kb)
  • MSc Workshop Feb 2019: Dominance analysis - solution (MS Excel , 95kb)
  • Three individuals (MS Excel , 1kb)
• MSc Workshop Feb 2018
  • MSc Equity Workshop - Instructions (MS Word , 28kb)
  • MSc Equity Workshop - Student File (MS Excel , 143kb)
  • MSc Equity Workshop - Solution File (MS Excel , 146kb)

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)