Incorporating social justice and stigma in cost-effectiveness analysis: drug-resistant tuberculosis treatment
Novel therapies for multidrug-resistant tuberculosis (MDR-TB) are likely to be expensive. The cost of novel drugs (e.g., bedaquiline, delamanid) may be so prohibitively high that a traditional cost-effectiveness analysis (CEA) would rate regimens containing these drugs as not cost-effective.
Traditional CEA may not appropriately account for considerations of social justice, and may put the most disadvantaged populations at greater risk. Using the example of novel drug regimens for MDR-TB, we propose a novel methodology, ‘justice-enhanced CEA', and demonstrate how such an
approach can simultaneously assess social justice impacts alongside traditional cost-effectiveness ratios. Justice-enhanced CEA, as we envision it, is performed in three steps: 1) systematic data collection about patients' lived experiences, 2) use of empirical findings to inform social justice
assessments, and 3) incorporation of data-informed social justice assessments into a decision analytic framework that includes traditional CEA. These components are organized around a core framework of social justice developed by Bailey et al. to compare impacts on disadvantage not otherwise
captured by CEA. Formal social justice assessments can produce three composite levels: ‘expected not to worsen…', ‘may worsen…', and ‘expected to worsen clustering of disadvantage'. Levels of social justice impact would be assessed for each major type of outcome
under each policy scenario compared. Social justice assessments are then overlaid side-by-side with cost-effectiveness assessments corresponding to each branch pathway on the decision tree. In conclusion, we present a ‘justice-enhanced' framework that enables the incorporation of social justice concerns into traditional CEA for the evaluation of new regimens for MDR-TB.
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Document Type: Research Article
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; School of Epidemiology & Public Health, University of Ottawa, Ottawa, Ontario, Canada
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
TB Proof, Cape Town, South Africa, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins Berman Institute of Bioethics, Baltimore, Maryland, USA
Publication date: November 1, 2017
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