Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia; Global Obesity Centre (GLOBE), Centre for Population Health Research, Deakin University, Geelong, Victoria, Australia.
Biostatics Unit, Faculty of Health, Deakin University, Geelong, Victoria, Australia.
Value Health. 2019 Feb;22(2):247-253. doi: 10.1016/j.jval.2018.07.006. Epub 2018 Aug 28.
There is an implicit equity approach in cost-effectiveness analysis that values health gains of socioeconomic position groups equally. An alternative approach is to integrate equity by weighting quality-adjusted life-years according to the socioeconomic position group.
To use two approaches to derive equity weights for use in cost-effectiveness analysis in Australia, in contexts in which the use of the traditional nonweighted quality-adjusted life-years could increase health inequalities between already disadvantaged groups.
Equity weights derived using epidemiological data used burden of disease and mortality data by Socio-Economic Indexes for Areas quintiles from the Australian Institute of Health and Welfare. Two ratios were calculated comparing quintile 1 (lowest) to the total Australian population, and comparing quintile 1 to quintile 5 (highest). Preference-based weights were derived using a discrete choice experiment survey (n = 710). Respondents chose between two programs, with varying gains in life expectancy going to a low- or a high-income group. A probit model incorporating nominal values of the difference in life expectancy was estimated to calculate the equity weights.
The epidemiological weights ranged from 1.2 to 1.5, with larger weights when quintile 5 was the denominator. The preference-based weights ranged from 1.3 (95% confidence interval 1.2-1.4) to 1.8 (95% confidence interval 1.6-2.0), with a tendency for increasing weights as the gains to the low-income group increased.
Both methods derived plausible and consistent weights. Using weights of different magnitudes in sensitivity analysis would allow the appropriate weight to be considered by decision makers and stakeholders to reflect policy objectives.
成本效益分析中存在一种隐含的公平方法，即平等地衡量社会经济地位群体的健康收益。另一种方法是根据社会经济地位群体对调整后的生命年进行加权，从而实现公平。
在澳大利亚，使用传统的无权重调整生命年来增加已有弱势群体之间的健康不平等的情况下，使用两种方法为成本效益分析推导公平权重。
使用流行病学数据，根据澳大利亚卫生福利协会的社会经济指数区五分位数，计算疾病负担和死亡率数据，推导出公平权重。计算了两个比率，分别比较五分位数 1（最低）与澳大利亚总人口的比率，以及五分位数 1 与五分位数 5（最高）的比率。使用离散选择实验调查（n=710）推导出基于偏好的权重。受访者在两个方案之间进行选择，方案中低或高收入群体的预期寿命有所不同。纳入预期寿命差异的名义值的概率模型用于估计计算公平权重。
流行病学权重范围为 1.2 至 1.5，以五分位数 5 为分母时权重更大。基于偏好的权重范围为 1.3（95%置信区间 1.2-1.4）至 1.8（95%置信区间 1.6-2.0），随着低收入群体收益的增加，权重呈上升趋势。
两种方法都推导出了合理且一致的权重。在敏感性分析中使用不同大小的权重将允许决策者和利益相关者考虑适当的权重，以反映政策目标。
