Distributional cost-effectiveness analysis: a tutorial

Distributional cost-effectiveness analysis (DCEA) is a framework for incorporating health inequality concerns into the economic evaluation of health sector interventions. In this tutorial we describe the technical details of how to conduct DCEA, using an illustrative example comparing alternative ways of implementing the NHS Bowel Cancer Screening Programme (BCSP). The two key stages in DCEA are (A) modelling social distributions of health associated with different interventions and (B) evaluating social distributions of health with respect to the dual objectives of improving total population health and reducing unfair health inequality. As well as describing the technical methods used, we also identify the data requirements and the social value judgements that have to be made. Finally, we demonstrate the use of sensitivity analyses to explore the impacts of alternative modelling assumptions and social value judgements.