Considering equity in priority setting using transmission models: Recommendations and data needs
M. Quaife,
GF Medley,
M. Jit,
T. Drake,
M. Asaria,
P. van Baal,
R. Baltussen,
L. Bollinger,
F. Bozzani,
O. Brady,
H. Broekhuizen,
K. Chalkidou,
Y.-L. Chi,
DW Dowdy,
S. Griffin,
H. Haghparast-Bidgoli,
T. Hallett,
K. Hauck,
TD Hollingsworth,
CF McQuaid,
NA Menzies,
MW Merritt,
A. Mirelman,
A. Morton,
FJ Ruiz,
M. Siapka,
J. Skordis,
F. Tediosi,
P. Walker,
RG White,
P. Winskill,
A. Vassall,
GB Gomez
Affiliations
M. Quaife
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
GF Medley
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
M. Jit
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
T. Drake
Center for Global Development in Europe (CGD Europe), UK
M. Asaria
LSE Health, London School of Economics, UK
P. van Baal
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands
R. Baltussen
Nijmegen International Center for Health Systems Research and Education, Radboudmc, the Netherlands
L. Bollinger
Economics and Costing, Avenir Health, USA
F. Bozzani
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
O. Brady
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
H. Broekhuizen
Centre for Space, Place, and Society, Wageningen University and Research, Netherlands
K. Chalkidou
International Decision Support Initiative, Imperial College London, UK
Y.-L. Chi
International Decision Support Initiative, Imperial College London, UK
DW Dowdy
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, USA
S. Griffin
Centre for Health Economics, University of York, UK
H. Haghparast-Bidgoli
Institute for Global Health, Centre for Global Health Economics, University College London, UK
T. Hallett
Department of Infectious Disease Epidemiology, Imperial College London, UK
K. Hauck
Department of Infectious Disease Epidemiology, Imperial College London, UK
TD Hollingsworth
Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, UK
CF McQuaid
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
NA Menzies
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, USA
MW Merritt
Johns Hopkins Berman Institute of Bioethics and Department of International Health, Johns Hopkins Bloomberg School of Public Health, United States
A. Mirelman
Centre for Health Economics, University of York, UK
A. Morton
Department of Management Science, University of Strathclyde, UK
FJ Ruiz
International Decision Support Initiative, Imperial College London, UK
M. Siapka
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK; Impact Elipsis, Greece
J. Skordis
Institute for Global Health, Centre for Global Health Economics, University College London, UK
F. Tediosi
Swiss Tropical and Public Health Institute and Universität Basel, Switzerland
P. Walker
Department of Infectious Disease Epidemiology, Imperial College London, UK
RG White
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, UK
P. Winskill
Department of Infectious Disease Epidemiology, Imperial College London, UK
A. Vassall
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK; Correspondence to: London School of Hygiene and Tropical Medicine, 15 – 17 Tavistock Place, London WC1H 9SH, UK.
GB Gomez
Department of Global Health and Development, London School of Hygiene and Tropical Medicine, UK
Objectives: Disease transmission models are used in impact assessment and economic evaluations of infectious disease prevention and treatment strategies, prominently so in the COVID-19 response. These models rarely consider dimensions of equity relating to the differential health burden between individuals and groups. We describe concepts and approaches which are useful when considering equity in the priority setting process, and outline the technical choices concerning model structure, outputs, and data requirements needed to use transmission models in analyses of health equity. Methods: We reviewed the literature on equity concepts and approaches to their application in economic evaluation and undertook a technical consultation on how equity can be incorporated in priority setting for infectious disease control. The technical consultation brought together health economists with an interest in equity-informative economic evaluation, ethicists specialising in public health, mathematical modellers from various disease backgrounds, and representatives of global health funding and technical assistance organisations, to formulate key areas of consensus and recommendations. Results: We provide a series of recommendations for applying the Reference Case for Economic Evaluation in Global Health to infectious disease interventions, comprising guidance on 1) the specification of equity concepts; 2) choice of evaluation framework; 3) model structure; and 4) data needs. We present available conceptual and analytical choices, for example how correlation between different equity- and disease-relevant strata should be considered dependent on available data, and outline how assumptions and data limitations can be reported transparently by noting key factors for consideration. Conclusions: Current developments in economic evaluations in global health provide a wide range of methodologies to incorporate equity into economic evaluations. Those employing infectious disease models need to use these frameworks more in priority setting to accurately represent health inequities. We provide guidance on the technical approaches to support this goal and ultimately, to achieve more equitable health policies.
