Universal or targeted cardiovascular screening? Modelling study using a sector-specific distributional cost effectiveness analysis

摘要: Distributional cost effectiveness analysis is a new method that can help to redesign prevention programmes by explicitly modelling the distribution of health opportunity costs as well benefits. Previously we modelled cardiovascular disease (CVD) screening audit data from Liverpool, UK see if city could its programme enhance and equity. Building on this previous analysis, examined looked at options co-designed with stakeholders. We simulated four plausible scenarios: a) no CVD screening, b) ‘current’ basic universal currently implemented, c) enhanced ‘increased’ population-wide delivery, d) ‘universal plus targeted’ top-up delivery most deprived fifth. also compared assumptions around whether displaced spend would come might benefit poor more how much these generate. The main outcomes were net change in slope index inequality (SII) QALYs per 100,000 person years. ‘Universal dominated reduced −0.65 Results are highly sensitive about and, particular, funding comes care or local government budgets. By analysing who loses gains expenditure decisions, distributional decision makers ways improve reduce inequality.