Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, MI, USA.
Value Health. 2023 Jun;26(6):943-952. doi: 10.1016/j.jval.2023.02.006. Epub 2023 Feb 18.
To identify differences in the approaches and results of studies that elicit equity-efficiency trade-offs that can inform equity-informative cost-effectiveness analysis for healthcare resource allocation.
We searched Ovid (Medline), EconLit, and Scopus prior to June 25, 2021. Inclusion criteria were: (1) peer-reviewed or (2) gray literature; (3) published in English; (4) survey-based; (5) parameterized a social welfare function to quantify inequality aversion or (6) elicited a trade-off in equity and efficiency characteristics of health interventions. Exclusion criteria were: (1) studies that did not conduct a trade-off or (2) theoretical studies. We abstracted details on study methods, results, and limitations. Studies were grouped by following approach: (1) social welfare function or (2) preference ranking and distributional weighting. We described findings separately for each approach category.
Seventy-seven papers were included, 28 parameterized social welfare functions and 49 were classified as preference ranking and distributional weighting. Study methods were heterogeneous. Studies were conducted across 29 countries. Sample sizes and composition, survey methods and question framing varied. Preferences for equity were mixed. Across both approach categories: 39 studies were classified as clear evidence of inequality aversion; 33 found mixed evidence; and 4 had no evidence of aversion. Evidence of between and within-study heterogeneity was found. Preferences for equity may differ by gender, profession, political ideology, income, and education.
Substantial variability in study methods limit the direct comparability of findings and their use in equity-informed cost-effectiveness analysis. Future researches using representative samples that explore within and between country heterogeneity is needed.
识别在引出公平-效率权衡的研究方法和结果方面的差异，为医疗资源配置的公平信息成本效益分析提供信息。
我们在 2021 年 6 月 25 日之前在 Ovid（Medline）、EconLit 和 Scopus 进行了检索。纳入标准为：（1）同行评议或（2）灰色文献；（3）以英文发表；（4）基于调查；（5）参数化社会福利函数以量化不平等厌恶程度，或（6）引出健康干预措施的公平和效率特征的权衡。排除标准为：（1）未进行权衡的研究，或（2）理论研究。我们提取了研究方法、结果和局限性的详细信息。研究按以下方法分组：（1）社会福利函数或（2）偏好排序和分布加权。我们分别描述了每种方法类别的发现。
共纳入 77 篇论文，其中 28 篇参数化了社会福利函数，49 篇被归类为偏好排序和分布加权。研究方法具有异质性。研究在 29 个国家进行。样本量和组成、调查方法和问题框架各不相同。对公平的偏好存在差异。在这两种方法类别中：39 项研究被归类为明显的不平等厌恶证据；33 项研究发现证据混合；4 项研究没有厌恶证据。发现了研究内和研究间的异质性证据。对公平的偏好可能因性别、职业、政治意识形态、收入和教育程度而异。
研究方法的大量差异限制了研究结果的直接可比性及其在公平信息成本效益分析中的应用。需要使用具有代表性的样本进行未来研究，以探索国家内部和国家之间的异质性。
