Why equal treatment is not always equitable: the impact of existing ethnic health inequalities in cost-effectiveness modeling

McLeod, Melissa; Blakely, Tony; Kvizhinadze, Giorgi; Harris, Ricci

doi:10.1186/1478-7954-12-15

Population Health Metrics

Table 3 Modeled lung, breast, and colon cancer interventions baseline and incremental benefits, incremental costs, and incremental cost-effectiveness, for Māori and non-Māori aged 50–54, 65–69, and 80–84 years, with varying input parameters (Models 1–5)

From: Why equal treatment is not always equitable: the impact of existing ethnic health inequalities in cost-effectiveness modeling

	50-54 years					65-69 years					80-84 years
	HALY per 100,000 pop^	Baseline HALY per case	Inc HALY per case	HALY per case% change	ICER	HALY per 100,000 pop^	Baseline HALY per case	Inc HALY per case	HALY per case% change	ICER	HALY per 100,000 pop^	Baseline HALY per case	Inc HALY per case	HALY per case% change	ICER
Lung cancer
Non-Māori
Model 1/2	41	4.13	1.49	0	13200	126	2.21	0.89	0	20000	98	1.01	0.37	0	40900
Model 3/4	39	3.64	1.41	-5.4	14000	116	1.80	0.81	-9.0	21800	82	0.69	0.31	-16.2	49100
Model 5	31	2.94	1.13	-24.2	17500	85	1.35	0.60	-32.6	29600	54	0.46	0.20	-45.9	74300
Māori
Model 1	145	4.02	1.47	0	13300	419	2.14	0.87	0	20200	230	1.00	0.37	0	40700
Model 2	127	2.90	1.29	-12.2	14600	346	1.52	0.72	-17.2	23000	185	0.74	0.30	-18.9	47600
Model 3	119	2.49	1.21	-17.7	15500	312	1.18	0.65	-25.3	25400	149	0.47	0.24	-35.1	59000
Model 4	105	2.25	1.07	-27.2	16900	260	1.03	0.54	-37.9	29500	126	0.43	0.20	-45.9	68200
Model 5	78	1.69	0.79	-46.3	22900	174	0.71	0.36	-58.6	44000	71	0.26	0.11	-70.3	120700
Breast cancer
Non-Māori
Model 1/2	65	17.53	0.74	0	24500	82	11.62	0.61	0	30000	40	6.07	0.25	0	66800
Model 3/4	64	16.80	0.73	-1.4	24800	81	10.92	0.60	-1.6	30500	39	5.49	0.24	-4.0	68900
Model 5	50	13.37	0.57	-23.0	31900	58	8.05	0.43	-29.5	42600	25	3.62	0.16	-36.0	107300
Māori
Model 1	109	17.26	0.75	0	24300	138	11.42	0.61	0	29800	68	6.04	0.25	0	66400
Model 2	141	15.84	0.96	+28.0	19900	172	10.28	0.76	+24.6	25000	87	5.56	0.32	+28.0	53700
Model 3	139	15.12	0.95	+26.7	20100	169	9.61	0.75	+23.0	25400	84	5.01	0.31	+24.0	55800
Model 4	122	13.63	0.83	+10.7	22400	135	8.17	0.60	-1.6	30600	66	4.28	0.24	-4.0	68600
Model 5	88	10.14	0.60	-20.0	31100	88	5.55	0.39	-36.1	47000	36	2.43	0.13	-48.0	126300
Colon Cancer
Non-Māori
Model 1/2	36	13.05	1.28	0	15300	159	8.95	0.85	0	22200	159	4.31	0.42	0	41400
Model 3/4	35	12.44	1.25	-2.3	15600	154	8.36	0.82	-3.5	22900	149	3.82	0.4	-4.8	44100
Model 5	28	9.99	1	-28	19600	112	6.19	0.6	-29.4	31300	98	2.52	0.26	-38.1	67400
Māori
Model 1	27	12.71	1.27	0	15300	114	8.64	0.83	0	22500	109	4.21	0.42	0	41700
Model 2	33	9.83	1.53	20.5	13300	138	6.75	1.01	21.7	19400	130	3.28	0.5	19	35900
Model 3	32	9.29	1.5	18.1	13600	133	6.23	0.97	16.9	20100	122	2.85	0.47	11.9	38400
Model 4	28	8.31	1.32	2.4	14900	110	5.27	0.8	-3.6	23400	100	2.42	0.38	-9.5	45700
Model 5	21	6.18	0.97	-23.6	20300	72	3.53	0.53	-36.1	35500	54	1.36	0.21	-50	83900

Model 1 – Ethnic-specific cancer incidence, non-Māori cancer excess mortality, and background mortality rates for all groups, no disability weights for cancer phases, no background population morbidity.
Model 2 – Same as Model 1, with ethnic-specific cancer excess mortality rate.
Model 3 – Same as Model 2, with disability weights for cancer phases.
Model 4 – Same as Model 3, with ethnic-specific background mortality rates.
Model 5 Heterogeneity model – Same as Model 4, with ethnic-specific background population morbidity.
^per 100,000 ethnic-specific resident population.
Note: The incremental cost per case for Model 1 was similar for Māori and non-Māori and reduced for Māori in Models 2 and 4 to be less than $2000 difference between Models 1–5.

Back to article page

ISSN: 1478-7954

Contact us

General enquiries: journalsubmissions@springernature.com