HEOR for All: Methodological Advancements to Promote Inclusivity and Equity in Healthcare Decision-Making

ISPOR’s vision statement calls for “a world where healthcare is accessible, effective, efficient, and affordable for all.”¹ Health equity, defined by the Centers for Disease Control as “the attainment of the highest level of health for all people,” is inherent to this vision.² Yet, while improving healthcare access for all is frequently listed as a priority in strategic plans and marketing materials in the health economic and outcomes research (HEOR) space, the field has been slow to adopt consistent and effective strategies to promote health equity. ISPOR 2025 sessions underscored this crossroads, highlighting both promising new tools and key barriers in translating these methodologies into action.

Health Equity in HTA

In a session that looked broadly at health disparities in HEOR, researchers presented a review that examined whether Health Technology Assessment (HTA) reports considered challenges related to health equity, particularly in the context of vulnerable populations impacted by health-related social needs.³ Out of 13 submissions for chimeric antigen receptor T-cell (CAR T-cell) therapies to Canada’s Drug Agency (CDA-AMC) and the National Institute for Health and Care Excellence (NICE), almost all acknowledged disparities in disease incidence and barriers in access to care that would likely disproportionately impact marginalised groups. However, these disparities were rarely quantified through economic models or clinical data analyses; furthermore, with only one exception, issues related to health equity were not cited as key factors in HTA decisions. While limited by the examination of HTA reports in only one indication and for two HTA bodies, this review further highlighted the overarching theme that, although the HEOR space has embraced the importance of health equity, its formal role in decision-making is not yet consistent.

Tools and Methodologies to Address Health Equity in HEOR

Throughout ISPOR, sessions drew attention to tools and methods HEOR professionals can utilise in their work to understand, measure and address structural and systemic barriers to health and healthcare:

• In an issue panel on the use of social determinants of health (SDOH) data in HEOR, speakers from industry and academia presented opposing perspectives on whether these data are “ready for primetime.” Dr. Amy O’Sullivan argued that the collection of SDOH data in electronic health records (EHR) and other real-world data (RWD) sources has improved in recent years, and presented an example of research that successfully leveraged the Area Deprivation Index (ADI), a tool that measures the relative social disadvantage of neighborhoods, in a predictive model.⁴ C. Daniel Mullins debated whether community-level metrics can really provide valuable insights into challenges faced by individuals; however, systematic reviews have shown that the ADI and similar tools are consistently associated with both health outcomes and healthcare spending.^{5, 6} Furthermore, SDOH data are often limited by high levels of missingness; however, community-level metrics such as the ADI only require that patient addresses be non-missing
• Speakers from the University of Illinois, McMaster University, and CDA-AMC presented on advancements in the EQ-5D-Y, a modified version of the EQ-5D designed to measure health-related quality of life in children and adolescents, a vulnerable population with unique challenges in access to care that may not be properly addressed by traditional HEOR methods and procedures.^{7, 8} The speakers presented on recent progress in EQ-5D-Y valuation in both the US and Canada, including preference elicitation directly from adolescents and children. These updates represent valuable opportunities to better incorporate the child’s perspective in HTA
• A flash-back to the Value in Health papers of the year for 2023 and 2024 reminded listeners of key opportunities and challenges associated with distributional cost-effectiveness analysis (DCEA), an extension of traditional cost-effectiveness analysis which evaluates how health costs and benefits are distributed across different population groups.⁹ While DCEA is a useful tool to incorporate health equity considerations into HTA, its consistent use is limited by inconsistent collection and reporting of the necessary subgroup data
• In a session on measuring the cost of inequality, speakers pointed out failures of standard health economic models to address the cost to society of unequal distributions of QALYs, and presented the Generalised Risk-Adjusted Cost-Effectiveness (GRACE) model, which integrates traditional cost-effectiveness analysis with social welfare functions to account for inequality.¹⁰ While GRACE is not new, there appears to be growing support within the HEOR community for its integration into decision-making processes to better capture societal welfare concerns compared to traditional models

Roadblocks and a Path Forward

A session on the changing landscape of US healthcare policy highlighted concerning implications for health equity, from disruptions of reimbursement for programs that benefit low-income families, to severe funding cuts for research that aims to understand and promote health in vulnerable populations.¹¹ However, a survey presented at ISPOR revealed that most Americans across party lines agreed or strongly agreed that Americans should have equal opportunity to be healthy and that improving the health of Americans should be a priority for the federal government.¹²

Overall, ISPOR 2025 reflected growing recognition within the HEOR community of the importance of health equity, but meaningful action remains elusive, and the current policy landscape presents significant challenges ahead. Looking forward, it is essential that HEOR professionals strive to engage and centre underrepresented and underserved patient populations in their work. As Dr. Zeba Khan, Editor-in-Chief of Value & Outcomes Spotlight, writes, “health equity isn’t an abstract goal; it’s a moral imperative. By dismantling barriers, promoting inclusivity, and advocating for systemic change, we can create a healthier, more equitable world.”