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Table 1 Summary of methods to incorporate vertical equity into economic evaluations

From: A cost-based equity weight for use in the economic evaluation of primary health care interventions: case study of the Australian Indigenous population

  Qualitative methods Quantitative methods
   Outcomes-based equity weights Cost-based equity weights
Basis for equity adjustment Decision-maker and/or stakeholder assessment of impact on equity Weighted QALYs - by direct weighting or characterisation of the social welfare function Costs weighted based on additional resources to provide improved access to health services
When performed Before or after calculation of cost-effectiveness ratios Incorporation into the benefits side of cost-effectiveness ratios Incorporation into the cost side of cost-effectiveness ratios
Examples Pluralistic bargaining
ACE 2nd stage filters [34]
Fair innings [38]
Cost-value analysis [6]
Proportional shortfall [3]
Cost side equity weight described in this paper
Main advantages of approach Less resource intensive than quantitative methods
Quick and doable with existing personnel
Explicit equity assumptions and judgements
Guidance on magnitude of resource redistributions based on social welfare
Explicit equity assumptions and judgements
Guidance on magnitude of resource redistributions based on solutions to inequity
Equity considered in health care processes rather than outcomes
Specific to context and definition of health for target group
Basis of weight simple to conceptualise
Comparable across different target groups
Main limitations of approach Equity judgements may be implicit
No guidance on magnitude of redistributions
Generally do not consider equity in processes of health care delivery
Not sensitive to differing preferences of target groups
Assumption of proportionality between magnitude of inequity and its solutions
Complex theoretical basis
Weight based on 'improved' rather than equitable access
May be resource intensive to construct
Dependent on a 'best practice' health service model being available for the target group
May lead to perverse incentives (i.e. reward inefficiency)
Untested in real policy decision contexts