Assessing Health Inequality through Distributional Cost-Effectiveness Analysis (DCEA): Lessons from Kidney Replacement Therapy in Thailand
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This study marks Thailand’s first application of Distributional Cost-Effectiveness Analysis (DCEA), demonstrating that the concept of “equity” can be incorporated into economic evaluation. The analysis examines dialysis options, namely peritoneal dialysis (PD) and hemodialysis (HD), for patients with end-stage renal disease (ESRD). This study built on the landmark cost-effectiveness study by Yot Teerawattananon et al. (2007), which provided pivotal policy evidence supporting the adoption of the PD-first policy under Thailand’s Universal Coverage Scheme.
DCEA requires the integration of clinical and cost data with inequality-related variables, such as socioeconomic status, geographical location, gender, and other social determinants of health. The effective development and application of DCEA depends on multi-sectoral collaborations among government agencies, research institutions, and healthcare providers to support access to required data and to consider the incorporation of equity into policy decisions.
Findings from this study underscored the importance of incorporating the equity dimension into economic evaluations as a key strategy for designing health policies that are not only “efficient”, but also “equitable.” Results from the DCEA of dialysis demonstrated that the “PD-first” policy was the cost-effective and equity-enhancing approach compared with an “HD-first” approach. The PD-first yielded better overall health outcomes while also reducing disparities.
