Equity Considerations in Health Economic Evaluations: A Systematic Review of WHO South-East Asia Region Countries.

Abstract: Equity-informative Cost-Effectiveness Analysis (CEAs) can promote fair healthcare access, yet their use in the WHO South-East Asia region (SEARO) is not well understood. This study aims to summarize methodological approaches, equity-relevant groups, health inequality measures, and healthcare provision areas addressed in equity-informative CEAs in SEARO countries. A systematic search was conducted in PubMed, Embase, Scopus, and Tufts CEA registry for equity-informative CEAs from WHO SEARO countries (2014-2023). CEAs with at least two alternative interventions and one equity criterion were included. Data extraction used Microsoft Excel. Interventions' distributional effects on cost-effectiveness were evaluated qualitatively, and bias was assessed using the CHEERS checklist. Of 828 studies identified, 10 were selected, nine from India (90%) and eight between 2014-2017 8 (80%). Studied groups included children, patients, the general population, adolescent girls, and neonates. All studies used cost-effectiveness analysis; 8 (80%) focused on healthcare providers' perspectives. Disability-Adjusted Life Years (DALYs) were primary outcome measures in 8 (80%) studies, while 9 (90%) assessed financial risk protection via out-of-pocket expenditure averted. Wealth quintiles were the equity criterion in 9 (90%) studies. About 6 (60%) conducted subgroup analyses and Extended Cost-Effectiveness Analyses (ECEA), with 2 (20%) using the Gini coefficient. Most studies 9 (90%) demonstrated 'greater value,' indicating improved public health implications. The scarcity of equity-informed CEAs in SEARO countries, excluding India, underscores the need for broader adoption. Improved public health implications highlight the necessity of equity-informed CEAs. Addressing these issues is essential to advance health equity in the SEARO region.