In response to the World Well being Group, “Three distinguishing options, when mixed, flip mere variations or variations in well being right into a social inequity in well being. They’re systematic, socially produced (and subsequently modifiable) and unfair.
That’s how an ISPOR Particular Curiosity Group Report by Griffiths et al. (2025) begins. The well being fairness primer supplies and overview of the literature. The paper identifies various key sources of social drawback: “socioeconomic standing, race and ethnicity, gender, geographic location, incapacity” amongst others.
Whereas decreasing well being disparities is a laudable aim, there are a selection of different priorities that additionally go into the social welfare perform together with “…concern for effectivity in growing whole well being, concern to prioritize severely sick sufferers, and concern for making certain acceptable procedures of determination making.” For example, ought to well being advantages be valued equally or ought to we worth well being advantages that accrue to extra deprived or extra severely sick sufferers extra. Who’s well being advantages ought to we worth extra: poor sufferers who’ve gentle illness or wealthy sufferers who’ve extreme illness? The solutions to those questions are usually not easy. Because the paper notes:
…measuring and addressing well being disparities is difficult given the interaction amongst many advanced components that form well being outcomes and may give rise to various moral considerations
The paper identifies completely different dimensions via which contemplating well being fairness considerations could possibly be helpful.
The paper additionally supplies examples of purposes of distributional price effectiveness evaluation (DCEA) and prolonged price effectiveness evaluation (ECEA). DCEA requires knowledge on no less than 4 key dimensions: (i) baseline well being inequalities (ii) distributional relative remedy results, (iii) the distribution of alternative prices, and (iv) inhabitants inequality aversion.
The authors spotlight 4 key sources of inequality:
- Want: What number of sufferers of a given group have a illness?
- Receipt: Amongst these in want, what number of have entry?
- Quick-term results: How do variations in baseline dangers for the situation in addition to the consequences of the intervention
- Lengthy-term results. Variations within the alternative price of funding the innovation
Whereas we now have strategies for quantifying the influence of latest well being applied sciences, there are nonetheless limitations. First, it’s unclear if key decisionmakers perceive the problems associated to well being disparities and/or if addressing these inequalities is a precedence for them. Second, well being disparity-inclusive financial modelling is extra knowledge intensive than customary CEA modelling. Third, well being fairness is just one dimension of broader societal worth that stakeholders ought to think about.
To study extra about evaluating well being fairness inside HEOR, I do suggest you learn the full paper.
