Incorporating health inequality impact into economic evaluation in low- and middle-income countries: a systematic review

ABSTRACT

Introduction

As well as improving population health, promoting equity in health is one of the key goals of health policy in low- and middle-income countries (LMICs). However, it is less clear how equity is defined, or how it may impact on resource allocation decisions. We investigated the degree to which health inequalities have been considered in economic evaluation of health interventions in LMICs, and what demographic or socioeconomic characteristics were used to define equity relevant subgroups.

Areas covered

We reviewed publications since 2010 from three main databases following the search strategy developed by including the key terms ‘health inequalities/health disparities/health equity,’ ‘economics’ and ‘low- and middle-income countries’ in the title or abstract. Twelve studies were identified, mainly focusing on interventions for the more vulnerable groups such as children and women.

Expert opinion

Some attempts have been made to assess interventions’ impact on health inequality and there is increasing interest in evaluating it, although research in this area is lacking. Population subgroups highlighted in the included studies were those differing in socioeconomic status. Most studies reported the results across subgroups to illustrate inequality impact, and the newly developed methods, extended cost-effectiveness analysis and distributional cost-effectiveness analysis, have also been applied.

KEYWORDS:

• Economic evaluation
• health inequality
• low- and middle-income countries
• public health
• systematic review

Article highlights

• In low- and middle-income countries, the impact on health inequality has been considered in economic evaluation of health interventions.

• The evaluation studies mainly focused on interventions for the more vulnerable groups such as children and women.

• There is an increasing trend to consider inequality impact to inform public health policy makers.

• Population subgroups characterized by socioeconomic status are most associated with of resource allocation and prioritization decisions.

• Most studies reported the results across subgroups to illustrate inequality impact, and some studies have also applied the ECEA or DCEA method.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Supplementary material

Supplemental data for this article can be accessed here

Additional information

Funding

This study was not funded.