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01.06.2017 | Original Paper | Ausgabe 4/2018 Open Access

The European Journal of Health Economics 4/2018

Incorporating equity in economic evaluations: a multi-attribute equity state approach

The European Journal of Health Economics > Ausgabe 4/2018
Jeff Round, Mike Paulden
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The online version of this article (doi:10.​1007/​s10198-017-0897-3) contains supplementary material, which is available to authorized users.


In publicly funded health care systems, decision makers must continually balance often conflicting priorities of efficiency and equity. Health economists have developed a set of highly sophisticated analytical methods for assessing efficiency, but less attention has been paid to formally incorporating equity considerations into analyses. As a result, where equity is considered is often informal, ad hoc and/or simplistic. This paper is a proposal for a mechanism for formally incorporating equity within the decision process. It begins with an overview of the current literature on equity weighting. It then considers the case of a single equity domain and illustrates how this is currently applied in practice by the UK’s National Institute for Health and Care Excellence. It then proposes a more comprehensive method for considering the multi-attribute equity state, where a population exhibits more than one trait considered worthy of differential weighting. Finally, the paper proposes a mechanism by which this could be applied in practice, and concludes with a discussion of the challenges for applying multi-attribute equity weighting.

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