Does incorporating cost-effectiveness analysis into prescribing decisions promote drug access equity?

Abstract

Using cost-effectiveness analysis (CEA) to inform prescribing can promote equitable drug access from a utilitarian perspective. Some theorists of equity, such as Rawls or Powers and Faden, however, would not consider CEA as promoting equity, as they endorse nonutilitarian theories of equity. Novel advances in CEA methodology seek to integrate broader equity concerns but may raise transparency concerns. We argue that incorporating CEA into qualitative multi-criteria decision analysis to inform prescribing decisions could promote equity more effectively and transparently than using CEA alone. Such applications should be implemented, along with recommendations, at the health system level rather than be carried out by individual clinicians alone.