Evidence of health inequalities by ethnic group for use alongside economic evaluation

Project theme: Methods development

There is increasing consideration of the impact of different types of interventions on health inequalities alongside more standard assessments of clinical and cost effectiveness. These concerns have been apparent for many years as part of the assessment of many public health interventions. These concerns are now extending in terms of a) the types of decisions where they are seen as relevant, moving downstream from public health interventions to assessment of health technologies including medicines and diagnostics; and b) the methods by which they are to be considered alongside assessments of economic efficiency. For example, in its most recent communications about its Methods Update, NICE states that “there remains a case for a [health inequalities] modifier” and “This would take into account the evidence of societal value linked to socioeconomic disadvantage, although we also note the importance of other sources of inequality. However, in order to formally establish this, it will be important in particular to understand different definitions and origins of inequalities…”

To date, much of the focus has been on the impact of health inequalities that arise due to socio-economic disadvantage. However, the evidence for the existence of health inequalities associated with other candidate groups, independently of socioeconomic status, is much less well established. This is particularly true in relation to health inequalities and ethnicity. There is a need to establish the extent to which health inequalities between different ethnic groups remain once socioeconomic status is appropriately controlled for. This needs to be established before decision makers can consider “inequality weights”, even if these are qualitative in nature. Analyses may need to address different measures of health, categorisations of ethnic group, and consider the roles of immigration status, language and other related factors. 


i)   To provide evidence of differences in measures of health related quality of life between (self-reported) ethnic groups, accounting for socio- economic status inter alia.

ii)   To work with policy makers, including NICE, to incorporate findings into recommendations for the use of “modifiers” for use alongside evidence of clinical and cost-effectiveness. 

iii)   To agree data requirements for extensions to the analysis that will help further inform policy needs.

Project Team

Monica Hernandez, Steve Pudney, and Allan Wailoo


Monica Hernandez



Hernandez Alava, M., Pudney, S., Wailoo, A. (2023) Ethnicity, socio-economic status and health. Policy Research Unit in Economic Evaluation of Health and Care Interventions. Universities of Sheffield and York. Report 069. DOI: https://doi.org/10.15131/shef.data.25219322