Dataset Information

The Impact of Funding Inpatient Treatments for COVID-19 on Health Equity in the United States: A Distributional Cost-Effectiveness Analysis.

ABSTRACT:

Objectives

We conducted a distributional cost-effectiveness analysis (DCEA) to evaluate how Medicare funding of inpatient COVID-19 treatments affected health equity in the United States.

Methods

A DCEA, based on an existing cost-effectiveness analysis model, was conducted from the perspective of a single US payer, Medicare. The US population was divided based on race and ethnicity (Hispanic, non-Hispanic black, and non-Hispanic white) and county-level social vulnerability index (5 quintile groups) into 15 equity-relevant subgroups. The baseline distribution of quality-adjusted life expectancy was estimated across the equity subgroups. Opportunity costs were estimated by converting total spend on COVID-19 inpatient treatments into health losses, expressed as quality-adjusted life-years (QALYs), using base-case assumptions of an opportunity cost threshold of $150 000 per QALY gained and an equal distribution of opportunity costs across equity-relevant subgroups.

Results

More socially vulnerable populations received larger per capita health benefits due to higher COVID-19 incidence and baseline in-hospital mortality. The total direct medical cost of inpatient COVID-19 interventions in the United States in 2020 was estimated at $25.83 billion with an estimated net benefit of 735 569 QALYs after adjusting for opportunity costs. Funding inpatient COVID-19 treatment reduced the population-level burden of health inequality by 0.234%. Conclusions remained robust across scenario and sensitivity analyses.

Conclusions

To the best of our knowledge, this is the first DCEA to quantify the equity implications of funding COVID-19 treatments in the United States. Medicare funding of COVID-19 treatments in the United States could improve overall health while reducing existing health inequalities.

SUBMITTER: Kowal S

PROVIDER: S-EPMC9525218 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Publications

The Impact of Funding Inpatient Treatments for COVID-19 on Health Equity in the United States: A Distributional Cost-Effectiveness Analysis.

Kowal Stacey S Ng Carmen D CD Schuldt Robert R Sheinson Daniel D Cookson Richard R

Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research 20221001 2

<h4>Objectives</h4>We conducted a distributional cost-effectiveness analysis (DCEA) to evaluate how Medicare funding of inpatient COVID-19 treatments affected health equity in the United States.<h4>Methods</h4>A DCEA, based on an existing cost-effectiveness analysis model, was conducted from the perspective of a single US payer, Medicare. The US population was divided based on race and ethnicity (Hispanic, non-Hispanic black, and non-Hispanic white) and county-level social vulnerability index (5 ...[more]

PMID: 36192293

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Project description:Examining the distributional equity of urban tree canopy cover (UTCC) has increasingly become an important interdisciplinary focus of ecologists and social scientists working within the field of environmental justice. However, while UTCC may serve as a useful proxy for the benefits provided by the urban forest, it is ultimately not a direct measure. In this study, we quantified the monetary value of multiple ecosystem services (ESD) provisioned by urban forests across nine U.S. cities. Next, we examined the distributional equity of UTCC and ESD using a number of commonly investigated socioeconomic variables. Based on trends in the literature, we predicted that UTCC and ESD would be positively associated with the variables median income and percent with an undergraduate degree and negatively associated with the variables percent minority, percent poverty, percent without a high school degree, percent renters, median year home built, and population density. We also predicted that there would be differences in the relationships between each response variable (UTCC and ESD) and the suite of socioeconomic predictor variables examined because of differences in how each response variable is derived. We utilized methods promoted within the environmental justice literature, including a multi-city comparative analysis, the incorporation of high-resolution social and environmental datasets, and the use of spatially explicit models. Patterns between the socioeconomic variables and UTCC and ESD did not consistently support our predictions, highlighting that inequities are generally not universal but rather context dependent. Our results also illustrated that although the variables UTCC and ESD had largely similar relationships with the predictor variables, differences did occur between them. Future distributional equity research should move beyond the use of proxies for environmental amenities when possible while making sure to consider that the use of ecosystem service estimates may result in different patterns with socioeconomic variables of interest. Based on our findings, we conclude that understanding and remedying the challenges associated with inequities requires an understanding of the local social-ecological system if larger sustainability goals are to be achieved.

Dataset Information

The Impact of Funding Inpatient Treatments for COVID-19 on Health Equity in the United States: A Distributional Cost-Effectiveness Analysis.

Objectives

Methods

Results

Conclusions

Publications

The Impact of Funding Inpatient Treatments for COVID-19 on Health Equity in the United States: A Distributional Cost-Effectiveness Analysis.

Similar Datasets

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