According to the World Health Organization, “Three distinguishing features, when combined, turn mere variations or differences in health into a social inequity in health. They are systematic, socially produced (and therefore modifiable) and unfair.

That is how an ISPOR Special Interest Group Report by Griffiths et al. (2025) begins. The health equity primer provides and overview of the literature. The paper identifies a number of key sources of social disadvantage: “socioeconomic status, race and ethnicity, gender, geographic location, disability” among others.

While reducing health disparities is a laudable goal, there are a number of other priorities that also go into the social welfare function including “…concern for efficiency in increasing total health, concern to prioritize severely ill patients, and concern for ensuring appropriate procedures of decision making.” For instance, should health benefits be valued equally or should we value health benefits that accrue to more disadvantaged or more severely ill patients more. Who’s health benefits should we value more: poor patients who have mild disease or rich patients who have severe disease? The answers to these questions are not straightforward. As the paper notes:

…measuring and addressing health disparities is challenging given the interplay among many complex factors that shape health outcomes and can give rise to diverse ethical concerns

The paper identifies different dimensions through which considering health equity concerns could be useful.

The paper also provides examples of applications of distributional cost effectiveness analysis (DCEA) and extended cost effectiveness analysis (ECEA). DCEA requires data on at least 4 key dimensions: (i) baseline health inequalities (ii) distributional relative treatment effects, (iii) the distribution of opportunity costs, and (iv) population inequality aversion.

• DCEA: Collins et al. (2020), Quan et al. (2021), Arnold et al. (2020)
• ECEA: Saenz-de-Miera et al. (2021), Essue et al. (2020)

The authors highlight 4 key sources of inequality:

• Need: How many patients of a given group have a disease?
• Receipt: Among those in need, how many have access?
• Short-term effects: How do differences in baseline risks for the condition as well as the effects of the intervention
• Long-term effects. Differences in the opportunity cost of funding the innovation

While we now have methods for quantifying the impact of new health technologies, there are still barriers. First, it is unclear if key decisionmakers understand the issues related to health disparities and/or if addressing these inequalities is a priority for them. Second, health disparity-inclusive economic modelling is more data intensive than standard CEA modelling. Third, health equity is only one dimension of broader societal value that stakeholders should consider.

To learn more about evaluating health equity within HEOR, I do recommend you read the full paper.