Chapter 4: Fairer Decisions, Better Health for All: Health Equity and Cost-Effectiveness Analysis

This chapter provides an introduction to methods for using cost-effectiveness analysis (CEA) to address health equity concerns, with applications to different country settings. These methods can provide information about the impacts of health investment decisions on inequalities in health and non-health outcomes, and they provide information about the trade-offs that sometimes arise between improving total health and reducing health inequalities. We distinguish two general ways of using CEA to address health equity concerns: (1) equity impact analysis, which quantifies the distribution of costs and effects by equity-relevant variables and (2) equity trade-off analysis, which quantifies the trade-offs between improving total health and other equity objectives. We hope this chapter will raise awareness of the practical tools of CEA that are now available to help give health care and public health policymakers a better understanding of who gains and who loses when making decisions.