Distributional cost-effectiveness analysis (DCEA) facilitates a quantitative assessment of how health effects and costs are distributed among population subgroups, and of any ensuing trade-offs between health maximisation and equity, thereby supporting consideration of equity impact in the decision-making process.

Under the base-case assumptions, alectinib improved societal welfare. Second-line atezolizumab involved a trade-off between reduction of health inequalities and decreasing population health and had the potential to improve societal welfare under certain assumptions. Given the uncertainty about the true marginal cost per quality-adjusted life-year in the National Health Service (i.e., the health opportunity cost), which is central to the analysis, the basis for its value should be carefully examined. Other key drivers in the analysis were the characteristics of the patient population (size, distribution by deprivation) and level of inequality aversion.

Each of these drivers raises important questions in terms of the implications for decision making. Guidance from health technology assessment organisations, such as NICE, is warranted on methods for DCEA construction and how they will interpret and incorporate results into their decision making.