Cost-effectiveness evaluations are part of health technology assessment of new interventions to inform efficient use but do not provide information to guide policy objectives related to health equity.

Distributional cost-effectiveness analysis is an intuitively appealing extension of conventional cost-effectiveness analysis to quantify health equity impacts and facilitate potential trade-offs between improving total health and health equity.

Gaps in the evidence base for a new intervention, for example because of limited clinical research participation among racial and ethnic minority groups, do not automatically render distributional cost-effectiveness analysis moot, futile, or vacuous. Employing a decision-modelling approach provides the framework to evaluate, understand, and communicate the implications of this uncertainty on health equity impact and estimates of value, and contributes to more honest policy discussions.