Contact Us

Home

About us

Services

AI Excellence

case studies

publications

HEOR Certificationheor Certification

AI for Medical Writing

Contact

  • Integrating Health Equity into Economic Decision-Making

    Integrating Health Equity into Economic Decision-Making

    For any health program, it is essential to check not just the total health gain but also who is receiving those gains; as fair decisions depend on both. Typical cost-effectiveness analysis (CEA) emphasizes efficacy by comparing costs and quality-adjusted life years (QALYs), indirectly considering all QALYs as equal in spite of whether they apply to the rich or poor, the healthy or severely ill, thus inadvertently increasing existing health disparities. Alternatively, equity-based approaches can make exact value decisions about minimizing inequitable and avoidable health gaps, using ethical theories, including egalitarianism and prioritarianism to validate giving extra importance to improvements in disadvantaged groups.(1-3)

    ​To implement equity factors, analysts first disaggregate costs and health outcomes by equity-relevant categories, including socioeconomic status, ethnicity, gender, region, or baseline health. This is done with the intention of estimating and not assuming the distributional effects of interventions. Extended or “equity-informative” CEA then informs subgroup-specific findings and inequality parameters, combined with standard incremental cost-effectiveness ratios (ICERs), enabling decision-makers to assess who benefits and who loses choosing different policy options without condensing everything into a single number. This descriptive step is often possible with fewer data enhancements and already offers a clearer base for deliberation about equity-efficiency trade-offs.(1)

    ​Distributional cost-effectiveness analysis (DCEA) specifically focuses on inequality in a social welfare framework that values both total health and its distribution. DCEA turns intervention costs into health opportunity costs and demonstrates alternative options for changing the distribution of lifetime health across groups, condensing the result with indices, including the equally distributed health that drops as inequality increases. By changing inequality aversion metrics, DCEA shows when a slightly less efficient intervention may be socially preferable since it provides larger gains to the worst off.(2)

    ​Equity weights applied to QALYs or disability-adjusted life years (DALYs) are another way to reinforce support for equity, by attributing higher weights to health gains for people who are poorer, more severely ill, or have larger lifetime health deficits. These weights can be obtained from empirical studies of public preferences or from ethical reasoning. However, they pose practical and ethical questions about how to draw and validate the chosen parameters in a clear, legitimate manner. Even when not used routinely as decision rules, equity-weighted analyses can explain how different social value findings would change intervention rankings.(4)

    ​Most health technology assessment (HTA) recommendations continue to prefer standard CEA and refer to equity only in broad terms, leaving distributional concerns to informal discussions rather than precise modelling. However, evidence suggests that incorporating equity considerations is not only feasible but also useful for decisions on screening, vaccination, and service delivery, for e.g., in low- and middle-income countries seeking universal health coverage.(1, 5) As methods, including extended CEA, DCEA, and equity weighting, are more widely applied, economic evaluation can transform into a more accessible, value-aware tool that facilitates transparent balancing of efficacy and equity in health policy.

    Become A Certified HEOR Professional – Enrol yourself here!

    References

    1. Muir JM, Radhakrishnan A, Ozer Stillman I, Sarri G. Health Equity Considerations in Cost-Effectiveness Analysis: Insights from an Umbrella Review. Clinicoecon Outcomes Res. 2024; 16:581-596.
    2. Asaria M, Griffin S, Cookson R. Distributional Cost-Effectiveness Analysis: A Tutorial. Med Decis Making. 2016; 36(1):8-19.
    3. Sivanantham P, Anandraj J, Ravel V, et al. Equity Considerations in Health Economic Evaluations: A Systematic Review of WHO South-East Asia Region Countries. WHO South-East Asia Journal of Public Health. 2024; 13(2): 69-77.
    4. Sassi F, Archard L, Le Grand J. Equity and the economic evaluation of healthcare. Health Technol Assess 2001; 5(3).
    5. Methods for the development of NICE public health guidance (third edition). 2012. [Accessed online on 22nd December 2025]. Available at: https://www.nice.org.uk/process/pmg4/chapter/incorporating-health-economics

    MarksMan Healthcare

    , ,

  • Advancing Health Equity through Health Economics and Outcomes Research

    Advancing Health Equity through Health Economics and Outcomes Research

    In a world where access to healthcare should be a universal right, the persistent disparities in health outcomes starkly remind us that health equity remains an elusive goal. Health equity is defined as the absence of unfair and avoidable differences in health among population groups defined socially, economically, demographically, or geographically. This concept underscores the need to ensure that every individual has a fair opportunity to achieve their highest possible level of health, unimpeded by systemic barriers or socioeconomic disadvantages.[1]

    Health Economics and Outcomes Research (HEOR) examines the cost-effectiveness, value, and real-world outcomes of healthcare interventions, enabling data-driven resource allocation. HEOR is pivotal in advancing health equity by analyzing the economic and clinical outcomes of healthcare interventions. HEOR evaluates the value of medical treatments and services, providing data-driven insights that inform decisions about the allocation of healthcare resources. By intertwining health equity with health economics, HEOR helps identify which interventions deliver the most significant benefits across diverse populations, guiding efforts to reduce disparities and improve overall health outcomes.[2]

    The COVID-19 pandemic showed how social determinants of health, such as income, occupation, and access to technology, impact health equity. Higher-income individuals often had the advantage of working from home, reducing their exposure to the virus and benefiting from better internet connectivity, which enabled access to virtual healthcare. In contrast, essential workers in lower-paying jobs faced greater exposure and limited healthcare access, leading to worse outcomes. These disparities highlight the urgent need to reevaluate healthcare practices and structures to address inequities effectively.[3-5]

    HEOR plays a critical role in this re-evaluation by incorporating cost-effectiveness analysis (CEA) to determine which healthcare interventions provide the most value. CEA can also include equity-weighted analyses that prioritize interventions benefitting disadvantaged populations. CEA compares the costs and outcomes of various strategies, enabling policymakers to allocate resources efficiently, especially in settings with limited healthcare budgets. For example, analyzing cancer screening programs’ cost-effectiveness can identify the most beneficial approach for underserved communities, ensuring that resources are directed where they can achieve the greatest impact.[6]

    Furthermore, HEOR’s focus on real-world evidence (RWE) extends beyond controlled clinical trials to understand how treatments perform in everyday practice. This evidence is essential for addressing health disparities, as it reflects the diverse experiences of different patient populations. For instance, RWE during the pandemic showed how vaccine hesitancy and limited access impacted vaccination rates in underserved communities, guiding targeted outreach campaigns. Studies might show that a particular medication is less effective in certain ethnic groups due to genetic variations or disparities in healthcare access, prompting the development of tailored strategies to improve outcomes for these groups.[7]

    Patient-reported outcomes (PROs) and electronic PROs (ePROs) are vital components of HEOR that enhance health equity by capturing patients’ perspectives on their health status, quality of life, and treatment satisfaction. Incorporating PROs and ePROs ensures that the voices of all patients, including those from marginalized groups, are considered in healthcare decision-making. This approach helps uncover specific challenges faced by different populations and informs the design of more inclusive and effective interventions.[8]

    HEOR also influences policy decisions by providing evidence on the broader social determinants of health, such as education, housing, and employment. Highlighting the impact of these factors on health outcomes allows HEOR to advocate for integrated policies that address these root causes of inequity. For instance, research showing that stable housing reduces emergency room visits has prompted healthcare systems to invest in housing assistance programs. In addition, research might demonstrate that improving access to quality education and stable housing can lead to better health outcomes and reduced healthcare costs, supporting the case for holistic approaches that combine social and health policies.[5]

    The pharmaceutical industry benefits significantly from integrating health equity into HEOR. By including diverse populations in clinical trials and subsequent research, companies can develop treatments that are effective across different demographic groups. Failing to include diverse populations can lead to treatments that are less effective or even harmful for certain groups, underscoring the importance of inclusive research practices. This approach not only improves health outcomes but also enhances market access and ensures compliance with regulatory requirements focused on diversity and inclusion.[7]

    In conclusion, advancing health equity through HEOR is both a moral imperative and a strategic necessity for optimizing healthcare delivery and outcomes. By embedding equity considerations into economic evaluations, RWE, PROs, and policy research, HEOR can guide the development of more inclusive healthcare strategies. This comprehensive approach ensures that all individuals, irrespective of their background, have access to the care they need to lead healthy and fulfilling lives. Moving forward, it is essential for all healthcare stakeholders to prioritize health equity in their research and decision-making processes, paving the way for a fairer and healthier future for all.

    Become A Certified HEOR Professional – Enrol yourself here!

    References:

    1. Health equity. World Health Organisation. Available from: https://www.who.int/health-topics/health-equity#tab=tab_1
    2. Fautrel B. SP0124 Health economics and health equity: two complementary disciplines.2017;76:31.
    3. Closing the Gap in a Generation: Health Equity Through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health. World Health Organization; 2008:1 -256. Available from: https://apps.who.int/iris/bitstream/handle/10665/43943/9789241563703_eng.pdf;jsessionid=365271ACE2052888542881700EEDCA8B?sequence=1.
    4. Burström B, Tao W. Social determinants of health and inequalities in COVID-19. European journal of public health. 2020 Aug 1;30(4):617-8.
    5. Thomas R, Chalkidou K. Cost–effectiveness analysis. InHealth system efficiency: How to make measurement matter for policy and management. 2016. European Observatory on Health Systems and Policies.
    6. Fendrick AM, ISPOR. Real-World Evidence: Additional Tool to Support Clinical Decision Making. Available from: https://www.ispor.org/docs/default-source/strategic-initiatives/ispor-rwe-byline-article_10-25-21.pdf?sfvrsn=687e4bc8_0
    7. Rosenberg SS, Carson BB, Kang A, Lee TH, Pandey R, Rizzo EJ. The Impact of Digital Health Technologies on Health Equity: Designing Research to Capture Patient-Reported Outcomes. ISPOR value & outcomes spotlight. Available from: https://www.ispor.org/publications/journals/value-outcomes-spotlight/vos-archives/issue/view/addressing-assessment-and-access-issues-for-rare-diseases/the-impact-of-digital-health-technologies-on-health-equity-designing-research-to-capture-patient-reported-outcomes.

    MarksMan Healthcare

    , , ,

  • Modelling Novel and Societal Value Elements for Holistic Value Assessment in HTA

    Modelling Novel and Societal Value Elements for Holistic Value Assessment in HTA
    Modelling Novel and Societal Value Elements for Holistic Value Assessment in HTA

    In the dynamic landscape of healthcare evaluation, methodologies for appraising the genuine value of medical innovations are experiencing profound evolution. The traditional framework of Health Technology Assessment (HTA), which has rested heretofore on the pillars of clinical efficacy and cost-effectiveness, is drastically expanded to include elements of novelty and value to the society. This is a transformation that aims at more comprehensive and holistic value assessment, in a manner that multifaceted benefits from healthcare advances can be appropriately acknowledged and valued.[1,2]

    Historically, HTA has been driven primarily by quantifiable metrics, principally Quality-Adjusted Life Years (QALYs) and direct economic impact. Such measures, while Important in their own right, often overlook broader societal implications, patient-centric outcomes, and innovation incentives. By integrating novel value dimensions, HTA can capture the entirety of the benefits that new technologies and treatments bring to patients and society.[2]

    One such novel dimension is the consideration of equity and access in value assessment. Creative treatments hold massive potential in promoting health equity, and can potentially reduce disparities in health outcomes between diverse population groups. For instance, personalized medicine can dramatically increase the effectiveness of treatment for historically marginalized populations developed from the presentation of the specific genetic profiles of patients. The integration of equity considerations in HTA ensures that interventions promoting broader access and reducing health disparities receive due recognition.[3,4]

    Modeling these holistic parameters demands sophisticated data analytics and simulation techniques. Traditional models such as Markov models and decision trees are evolving to encompass broader societal values. Health economic models now incorporate variables for productivity losses, caregiver burden, and social equity impacts, providing a more nuanced representation of the value of the intervention. These models simulate long-term outcomes and costs associated with healthcare interventions, equipping stakeholders with comprehensive data to inform decision-making.[5]

    Additionally, there is a growing interest in societal value elements of HTA, including productivity gains and reduction in caregiver burden. It is absolutely necessary to determine the extent to which new therapies would make patients return to work and contribute economically, as well as the relief they offer to caregivers. Treatments that enable patients with chronic diseases to stay employed not only improve individual quality of life but also reduce broader societal economic burdens. Similarly, treatments alleviating the physical and emotional strain on caregivers yield substantial societal value, enhancing overall community well-being.[1,6]

    Advanced modeling methods, like microsimulation and dynamic simulation models, are peculiarly suited to capture such societal benefits. Microsimulation models can look at the trajectories over time of individual patients that might outline subtle impacts of healthcare interventions on productivity and caregiver burden. For example, through the use of dynamic simulation models, it would be possible to gain insights into how a new Alzheimer’s disease treatment could influence the long term cognitive function of patients while simultaneously reducing caregiver stress and societal healthcare costs over the long term.[7]

    Moreover, the Multi-Criteria Decision Analysis (MCDA) model brings further sophistication to HTA. In this respect, MCDA provides a very structured framework within which different health interventions can be evaluated and compared according to multiple criteria, hence representing a much more comprehensive measure of their value. In applying MCDA, stakeholders have a better possibility of weighing and prioritizing different value dimensions in a more transparent way, thus enabling more informed and balanced decision-making in HTA processes.[8]

    Several HTA authorities are at the forefront of integrating these holistic parameters. For example, the National Institute for Health and Care Excellence (NICE) in the UK has already begun incorporating broader societal benefits and impact assessments into its review process. Similarly, the Canadian Agency for Drugs and Technologies in Health (CADTH) is increasing the emphasis on patient and caregiver perspectives in its reviews. All of these organizations are working to provide a standard for holistic value assessment and concrete practical application of these cutting-edge methodologies.[9]

    The evolution of Health Technology Assessment (HTA) is a major step towards a much more extensive approach to healthcare assessment. By bringing on board novelty and societal value attributes along with sophisticated modeling techniques, HTA will be better placed to really capture the full spectrum of benefits offered by medical innovations. This new development adds to the objectivity of value assessments but goes ahead to establish a commitment to fairness, innovation, and patient-centricity. As organizations begin to fine-tune methodologies and include different perspectives from various stakeholders, the slowly evolving landscape of healthcare becomes all the more inclusive and responsive to societal needs. In essence, this evolution in HTA reflects a broader commitment to informed decisions and improved patient outcomes, paving the way for a healthcare system that prioritizes effectiveness, equity, and the well-being of all individuals.

    Become A Certified HEOR Professional – Enrol yourself here!

    References

    1. Culyer AJ. “Perspectives” in health technology assessment. AMA Journal of Ethics. 2021 Aug 1;23(8):619-23.
    2. Drummond MF, Sculpher MJ, Claxton K, Stoddart GL, Torrance GW. Methods for the economic evaluation of health care programmes. Oxford university press; 2015 Sep 25.
    3. Garrison LP, Jansen JP, Devlin NJ, Griffin S. Novel approaches to value assessment within the cost-effectiveness framework. Value in Health. 2019 Jun 1;22(6):S12-7.
    4. Benkhalti M, Espinoza M, Cookson R, Welch V, Tugwell P, Dagenais P. Development of a checklist to guide equity considerations in health technology assessment. International journal of technology assessment in health care. 2021 Jan;37(1):e17.
    5. K de Bienassis K, Slawomirski L, Klazinga NS. The economics of patient safety Part IV: Safety in the workplace: Occupational safety as the bedrock of resilient health systems.
    6. Drost RM, Paulus AT, Evers SM. Five pillars for societal perspective. International journal of technology assessment in health care. 2020 Apr;36(2):72-4.
    7. Cuijpers Y, Van Lente H. Early diagnostics and Alzheimer’s disease: Beyond ‘cure’and ‘care’. Technological Forecasting and Social Change. 2015 Apr 1;93:54-67.
    8. Marsh K, Thokala P, Youngkong S, Chalkidou K. Incorporating MCDA into HTA: challenges and potential solutions, with a focus on lower income settings. Cost Effectiveness and Resource Allocation. 2018 Nov;16:1-9.
    9. Canadian Agency for Drugs and Technologies in Health. CADTH framework for patient engagement in health technology assessment. 2019. https://www.cadth.ca/cadth-framework-patient-engagement-health-technology-assessment-0.

    MarksMan Healthcare

    , , ,

  • Health Equity: Defining, Measuring, and Advancing the Path Towards Inclusive Well-being

    Health Equity: Defining, Measuring, and Advancing the Path Towards Inclusive Well-being

    Health equity is a foundational principle within public health, envisioning a world where everyone, regardless of circumstance, has the opportunity to flourish and reach their full health potential. It goes beyond the absence of disease, emphasizing the fair and just distribution of resources, opportunities, and health outcomes across diverse populations. Achieving this complex and multifaceted challenge requires a deep understanding of the social determinants of health (SDH) and identifying systemic disparities that create unjust gaps.[1]

    The World Health Organization (WHO) identifies SDH as the conditions in which we are born, grow, live, work, and age. These upstream factors significantly impact health outcomes and encompass income, education, employment, housing, social support networks, and even exposure to environmental hazards. Addressing health equity necessitates acknowledging and addressing these upstream factors that contribute to disparities.[2]

    Health equity differs from health equality. While equality implies providing everyone with identical resources, equity acknowledges that individuals have unique needs and starting points on their health journeys. It focuses on closing the health gap and ensuring everyone has an equal chance at a healthy life, irrespective of background or social position. This necessitates dismantling avoidable and unjust health disparities rooted in social, economic, and environmental factors.[2] Understanding health equity demands embracing intersectionality. This acknowledges that individuals exist at the crossroads of multiple identities, such as race, gender, socioeconomic status, and more. These intersecting identities can act as multipliers or mitigators of the impact of SDH on health outcomes.[3]

    Measuring health equity presents a challenge due to its multifaceted nature and the interplay of various determinants. Nevertheless, established methodologies and indicators act as valuable tools to assess the extent of equity within a population. One approach involves analyzing disparities in health outcomes across different population groups. This includes assessing variations in mortality rates, morbidity, and life expectancy. By comparing these outcomes among diverse demographic groups, analysts can identify areas requiring particular attention and address the underlying factors contributing to disparities.[3]

    Socioeconomic indicators such as income, education, and occupational status play a crucial role in understanding health disparities, with variations in these factors often aligning with differences in health outcomes. This emphasizes the interconnection between social factors and health and underscores the imperative to tackle broader social determinants for the attainment of genuine health equity.[2,3]

    Evaluating access to healthcare services is crucial. Disparities in affordability, availability, and accessibility can create significant barriers to necessary medical care, leading to differential health outcomes. Identifying these barriers through metrics like healthcare facility availability, service affordability, and transportation options sheds light on the specific challenges faced by different groups.[2,3]

    Analyzing health behaviors like smoking, physical activity, and dietary habits provides insights into health equity. Variations in these behaviors often stem from cultural, socioeconomic, or environmental factors beyond individual choices. Recognizing these influences allows for targeted interventions that promote healthier lifestyles and address the root causes of disparities.[2]

    An intersectional analysis involves examining health outcomes while considering multiple social identities simultaneously. This approach recognizes the unique challenges faced by individuals with intersecting identities and helps tailor interventions to their specific needs. By disaggregating data based on various demographic factors, researchers can uncover hidden disparities that might be masked in aggregated analyses, leading to more nuanced and effective interventions.[3,4]

    While these methods offer valuable insights, challenges persist in capturing the full complexity of health equity. Data availability and quality, particularly for marginalized and underserved populations, can pose significant limitations. Additionally, the dynamic nature of social determinants necessitates ongoing adaptation and refinement of measurement strategies.[3,4]

    Health equity is more than just a concept; it’s a moral imperative and a guiding principle in public health. Addressing it necessitates a comprehensive understanding of the social determinants of health and a commitment to dismantling systemic disparities. Measurement methods play a crucial role in assessing progress, identifying areas for intervention, and ensuring we leave no one behind. By employing a combination of these tools and continuously refining them, we can work towards a future where everyone, regardless of background or circumstance.

    Become A Certified HEOR Professional – Enrol yourself here!

    References

    1. Braveman, P.A.; Arkin, E.; Orleans, T.; Proctor, D.; Plough, A. What is Health Equity? And What Difference Does a Definition Make? Robert Wood Johnson Foundation: Princeton, NJ, USA, 2017.
    2. Braveman P. Health disparities and health equity: concepts and measurement. Annu. Rev. Public Health. 2006 Apr 21;27:167-94.
    3. Hoyer D, Dee E, O’Leary MS, Heffernan M, Gelfand K, Kappel R, Fromknecht CQ. How do we define and measure Health Equity? The state of current practice and tools to Advance Health Equity. Journal of Public Health Management and Practice. 2022 Sep 1;28(5):570-7.
    4. Penman-Aguilar A, Talih M, Huang D, Moonesinghe R, Bouye K, Beckles G. Measurement of health disparities, health inequities, and social determinants of health to support the advancement of health equity. Journal of public health management and practice: JPHMP. 2016 Jan;22(Suppl 1):S33.

    MarksMan Healthcare

    , , ,

  • The Economics of Social Determinants of Health and Health Equity

    The Economics of Social Determinants of Health and Health Equity

    The World Health Organization Health (WHO) defines health as “a state of complete physical, mental and social well-being; and not merely the absence of disease or infirmity.”[1] Health is influenced by medical and non-medical determinants which contribute to health inequities; the non-medical determinants of health are also referred to as the social determinants of health (SDH).

    As per WHO, social determinants of health are ‘the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems that shape the conditions of daily life’. These forces include economic policies and systems, development agendas, social norms, social policies, and political systems.[2] The SDHs play a role in quality of life (QoL) and functioning at the individual level. They include classic non-medical factors such as gender, social class, income, socioeconomic status, education, ethnicity, culture, and neighbourhood. These days, SDHs also include other factors influencing education, employment, and the living environment, such as social safety, social capital, immigration, racism, religion, colonialism, legal status, addiction, unemployment, and legal status.[3] SDHs also include factors such as accessible healthcare and education, race and ethnicity, safe environmental conditions, and food insecurity, and intangible factors such as political, socioeconomic, and cultural beliefs. SDHs are shaped by the distribution of money, power and resources at global, national and local levels.[4]

    It is well known that SDH contribute to many of the major health conditions including obesity, heart disease, diabetes, and depression.[5] It has also been realised that SDH are among the main factors resulting in avoidable health inequalities between different groups of people, within and between countries, by creating stratification in societies. In this context, the WHO established a commission on SDH in 2005 to support countries and global health partners in addressing the social factors that lead to poor health and health inequities. The aim of the commission was to draw attention of the governments and society towards the social determinants of health and create better conditions for health.[6]

    Research on SDH is also essential to determine the value of healthcare delivery. It is increasingly realised that value-based models of healthcare systems impart positive results on the whole society rather than individuals. Holistic approach by healthcare providers to enhance patient care and to promote superior outcomes can increase the value of healthcare organizations. These are invariably tied to the complex circumstances in which people are born and live, which in turn determine the SDH.

    Identifying SDH can help analyze the care to be provided to the people, and the care yet to be received by the people. In this context, electronic health records (EHRs) can be an invaluable source of information on SDH. EHRs have been mined for obtaining structured and unstructured data on type of care provided, clinical outcomes, survival, adverse effects, and factors determining the same. The social and demographic data about patients on the other hand is of great value in understanding the social angle of health, and helps deliver positive healthcare outcomes.[7]

    Economists often justify SDH interventions based on ‘efficiency’ and ‘equity’ aspects. SDH interventions are needed for the efficient allocation of resources, and are also required for the equitable distribution of public policy pertaining to healthcare delivery. Recent economic thinking suggests that there should be a synergistic approach between efficiency and equity for the purpose of SDH interventions. The core concept is that a resource redistribution to achieve equity does have a price, but sometimes this price is worth paying. The role of economists is to find the least costly strategy to achieve equity and efficiency, ultimately resulting in social welfare, not just in the health aspect, but from a holistic viewpoint. In fact, there are many examples (such as SDH interventions for early child development) where efficiency and equity are shown to mutually enhance each other.[8]

    SDH have considerable impact on the treatment outcomes as well: interventions that target SDH are often required in addition to therapy for improving the patient’s health. However, for mobilizing investment in SDH interventions, the value for money of those interventions should be firmly established. For any SDH intervention to have value for money, it is essential to assess whether the SDH intervention can bring about measurable changes in health outcomes. Any SDH intervention is likely to be multifaceted, and the outcomes need not be limited to the health sector alone. In this context, it is also essential to take into account all the potential benefits of the intervention. All these benefits must be incorporated when performing an economic evaluation of the SDH intervention.[8]

    The economic argument surrounding the value for money of any SDH intervention depends on the evidence of effectiveness of the SDH intervention. In this context, it is necessary to examine the impact of the SDH intervention in the desired primary area, that is, to improve health. For example, the beneficial impact of SDH interventions targeting early childhood education should be evaluated in the context of improving health in terms of improved childhood vaccination, increased hygiene, reduced school absenteeism, and an overall reduced incidence of pediatric hospitalization due to avoidable diseases. Evaluation of SDH interventions that target economic welfare and social protection through targeted conditional cash transfers in middle-income and low-income countries should also include evaluation of the improvement in health of the beneficiaries as an outcome of the intervention. Interventions targeting urban development, such as affordable housing, assistance for improving internal conditions of houses, slum upgrading, traffic calming programmes, and developing public parks and swimming pools, also appear to have a positive impact on a number of health outcomes, and these need to be evaluated.[8]

    In this context, there are multiple research gaps concerning the economics of SDH interventions:

    • Most evidence originates from, and thus is biased towards, high-income countries.
    • Evidence generation through randomization for SDH interventions is laden with a multitude of ethical, moral, social, and humanistic hurdles. Thus, causal impact of SDH interventions is often challenging to assess.
    • It is challenging to accurately quantify the multifaceted benefits of the SDH interventions in monetary terms.

    The SDH are thus an important concept that can alter the health of a large number of individuals, and are responsible for poor health outcomes despite the availability of well-designed health programmes. SDH interventions are essential not only to improve the efficiency and equity of health programmes, but also to enhance the living standards of people in a multifaceted way. Scientifically sound and robust methods are needed to be developed to accurately evaluate the value-for-money of different SDH interventions.

    Become A Certified HEOR Professional – Enrol yourself here!

    References

    1. https://www.who.int/about/governance/constitution
    2. https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1
    3. Islam MM. Social Determinants of Health and Related Inequalities: Confusion and Implications. Front Public Health. 2019 Feb 8;7:11.
    4. https://www.medicalnewstoday.com/articles/social-determinants-of-health
    5. https://catalyst.nejm.org/doi/full/10.1056/CAT.17.0312
    6. https://www.who.int/teams/social-determinants-of-health/equity-and-health/commission-on-social-determinants-of-health
    7. Gold R et al. Adoption of Social Determinants of Health EHR Tools by Community Health Centers. Ann Fam Med. 2018 Sep;16(5):399-407 https://apps.who.int/iris/bitstream/handle/10665/84213/9789241548625_eng.pdf

    MarksMan Healthcare