Equity-Adjusted Value: A Distributional Cost-Effectiveness Framework

Rubin et al. show rare disease CEAs are distorted by discounting and utility assumptions, while Sahu et al.’s HIV model highlights interventions benefiting high-risk groups (adolescent girls). This research creates a "Distributional CEA" framework that: (a) assigns equity weights to patient subgroups (e.g., higher weight for low-income or rural populations), (b) quantifies opportunity costs of equity trade-offs, and (c) visualizes impacts on inequality indices. Unlike Jiang et al.’s HPV vaccine CEA (which uses flat societal WTP), this would ask: "Is the intervention more valuable if it primarily benefits the underserved?" It operationalizes Zechmeister-Koss’s critique of CEA’s values-blindness and could transform HTA in universal health systems.

References:

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