Addressing inequity in genomics: Normative and pragmatic considerations in using distributional cost-effectiveness analysis to guide decision making

Distributional cost-effectiveness analysis (DCEA) is emerging as a health economic method to characterize the effects of health care interventions in terms of the distribution of benefits and burdens among population groups. Results thus provide evidence to decision makers that explicitly quantify the equity and efficiency trade-offs of implementing an intervention, and decision makers may choose to prioritize one goal or another alongside considerations of safety and effectiveness. Transparency of this process may be seen as a “reimagined benefit” of health technology assessment (HTA). DCEAs may be particularly useful in genomic medicine given longstanding concerns about such interventions may exacerbate health inequities by differentially benefitting some groups over others, yet there are challenges that must be addressed. This interdisciplinary panel assembles researchers with expertise in health economics, evidence synthesis, ethics, and genomics law and policy. Panelists will present a critical and pragmatic overview of normative and technical aspects of DCEA and its application in HTA, with an emphasis on articulating the role of social values in examination of equity and efficiency trade-offs and whether and how the method might guide future social science research in genomics.

Authors: Hadley Smith, Harvard Medical School and Harvard Pilgrim Health Care Institute; Jeroen Jansen, University of California, San Francisco; Shawn Winsor, University of Toront; Shawneequa Callier, George Washington University