equity impact plane
The equity impact plane is a visual tool that helps decision-makers understand the trade-offs between improving overall health and addressing health equity. It shows whether a health intervention increases or decreases both total health and health equity, allowing for more informed choices when resources are limited.
At a glance
Use when
Evaluating health interventions where differential impacts across population subgroups are expected or of policy concern, especially in contexts with significant health inequalities.
Avoid when
Disaggregated data by equity-relevant variables are unavailable or unreliable, or when the intervention is expected to have uniform effects across all population groups.
Inputs
Distribution of costs and health effects by equity-relevant variables (e.g., socioeconomic status, ethnicity, severity of illness), baseline health inequality metrics, opportunity cost estimates.
Outputs
Visualization of trade-offs between total health and equity, classification of interventions by equity and efficiency impact, quantified forgone health due to equity-oriented choices, results from equity-weighted analyses.
How it works
The equity impact plane is a bivariate framework that plots changes in total health (e.g., aggregate QALYs) against changes in health equity (e.g., reduction in inequality across socioeconomic groups) resulting from a health intervention. It enables classification of interventions into four quadrants: win-win (improves both total health and equity), lose-lose, trade-off (improves one at the expense of the other), and redistribution. It supports equity impact analysis and equity trade-off analysis within cost-effectiveness assessments using disaggregated data by equity-relevant variables.
- HTA domains
- Clinical Effectiveness, Patient and Social Aspects, Aspects Beyond HTA
- Categories
- AppraisalHeterogeneity
- Assumptions
- Health equity can be meaningfully measured and compared with total health gains; opportunity costs are distributed fairly across populations; data are available to disaggregate outcomes by equity-relevant characteristics.
- Strengths
- Makes equity trade-offs explicit and transparent,Integrates equity considerations into standard cost-effectiveness frameworks,Supports structured decision-making in health technology assessment,Can be applied using existing CEA data with additional stratification
- Limitations
- Requires high-quality, disaggregated data by equity variables,Choice of equity metric influences results and interpretation,Does not resolve ethical disagreements about the value of equity vs. efficiency
- Also known as
- equity impact framework, equity-efficiency plane
Questions this answers
- › Does the intervention improve total health and reduce health inequalities?
- › Who benefits and who loses in terms of health and costs across different population groups?
- › What is the trade-off between cost-effectiveness and equity?
- › How much health gain is forgone to achieve greater equity?
- › How sensitive is the optimal decision to different levels of concern for equity?
- › Can a less cost-effective intervention be justified on equity grounds?
References & sources
Related methods
Similar by meaning
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