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

Jeff Round*, Mike Paulden

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)peer-review

11 Citations (Scopus)
284 Downloads (Pure)


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.

Original languageEnglish
Pages (from-to)489-498
Number of pages10
JournalEuropean Journal of Health Economics
Issue number4
Early online date1 Jun 2017
Publication statusPublished - 1 May 2018


  • Cost-effectiveness
  • Distributional weights
  • Equity
  • Equity weights

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