Table 1.

Description of potential ways to integrate social justice concerns into economic evaluation

Solution	Potential way to integrate social justice concerns	Social justice input required
‘Direct’ approaches
Equity weighting (rank-dependent QALY model)	Express as weights (for gains and losses) or as ranks of outcome profiles	Prior to the analysis, the magnitude of weights or ranks should be explicitly stated
Distributional CEA	Use as the basis to formulate inequality quantiles for which opportunity cost and outcome impact are formed	Inequality quantiles should be identified to initiate empirical estimation of differential distributions
Mathematical/linear programming	Transform into constraints used in the programming formulation	Requires constraints to be explicitly, algebraically formulated to initiate the programming
Stratified CEA	Use as the basis to define strata for which cost-effectiveness is considered separately	Entails that strata are a priori defined to obtain necessary input
‘Indirect’ approaches
MCDA with quantitative comparison	Determine criteria and their relative importance against other criteria and cost-effectiveness	Operationalization and quantification of considerations, explicitly assigning relative importance
MCDA with mixed comparison	Set quantified criteria; however, without numerical comparison against cost-effectiveness	Quantification of considerations and their assessment (possibly implicit) against others in a qualitative manner
MCDA with qualitative comparison	Form criteria that are reported in narrative form alongside cost-effectiveness	Narrative description of decided criteria and their qualitative appraisal (possibly implicit) against other criteria

CEA: Cost-effectiveness analysis; MCDA: Multicriteria decision analysis; QALY: Quality-adjusted life year