Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2026
Incorporating Equity Considerations Related to Financial Protection Through Extended Cost-Effectiveness Analysis: A Systematic Review.
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Khuntha Sarayuth, Youngkong Sitaporn, Sitthiboot Ukrit, Thavorncharoensap Montarat, Chaikledkaew Usa, Thakkinstian Ammarin
Аннотация
OBJECTIVES: Extended cost-effectiveness analysis (ECEA) incorporates financial risk protection (FRP) and distributional outcomes across socioeconomic groups. This study assessed FRP outcomes and synthesized the landscape of ECEA applications.
METHODS: A systematic literature search was conducted in PubMed, Scopus, International Network of Agencies for Health Technology Assessment (INAHTA) Database, and Tufts Medical Center's Cost-Effectiveness Analysis Registry from January 1, 2010, to June 1, 2025. Studies were included if they report FRP outcomes, such as out-of-pocket expenditure, cases of catastrophic health expenditure, cases of poverty, value of insurance, or indirect costs. Study quality was appraised using the Economic Evaluation Bias Assessment (ECOBIAS) checklist. The distribution of FRP outcomes across socioeconomic groups was assessed to determine whether benefits were propoor or prorich.
RESULTS: Thirty-nine studies were included from 5212 records screened. Most studies evaluated out-of-pocket expenditure (n = 31), followed by catastrophic health expenditure cases (n = 22), poverty cases (n = 16), value of insurance (n = 9), and indirect costs (n = 3). Propoor FRP impacts were consistently reported for tobacco taxation, immunization, and other infectious disease interventions. In contrast, some interventions, such as alcohol pricing and unhealthy diet policies, showed mixed effects depending on the FRP metric applied and the income setting. Overall, study quality was generally high, although methodological approaches and outcome definitions varied across studies.
CONCLUSION: ECEA has expanded in scope and application, demonstrating its value in identifying interventions that reduce financial hardship. FRP benefits represent a critical dimension for promoting equity. Policymakers should incorporate ECEA to ensure that financial protection is evaluated alongside other values.
METHODS: A systematic literature search was conducted in PubMed, Scopus, International Network of Agencies for Health Technology Assessment (INAHTA) Database, and Tufts Medical Center's Cost-Effectiveness Analysis Registry from January 1, 2010, to June 1, 2025. Studies were included if they report FRP outcomes, such as out-of-pocket expenditure, cases of catastrophic health expenditure, cases of poverty, value of insurance, or indirect costs. Study quality was appraised using the Economic Evaluation Bias Assessment (ECOBIAS) checklist. The distribution of FRP outcomes across socioeconomic groups was assessed to determine whether benefits were propoor or prorich.
RESULTS: Thirty-nine studies were included from 5212 records screened. Most studies evaluated out-of-pocket expenditure (n = 31), followed by catastrophic health expenditure cases (n = 22), poverty cases (n = 16), value of insurance (n = 9), and indirect costs (n = 3). Propoor FRP impacts were consistently reported for tobacco taxation, immunization, and other infectious disease interventions. In contrast, some interventions, such as alcohol pricing and unhealthy diet policies, showed mixed effects depending on the FRP metric applied and the income setting. Overall, study quality was generally high, although methodological approaches and outcome definitions varied across studies.
CONCLUSION: ECEA has expanded in scope and application, demonstrating its value in identifying interventions that reduce financial hardship. FRP benefits represent a critical dimension for promoting equity. Policymakers should incorporate ECEA to ensure that financial protection is evaluated alongside other values.