Governments and health technology assessment agencies are putting greater focus on and efforts in understanding and addressing health inequities. Cost-effectiveness analyses are used to evaluate the costs and health gains of different interventions to inform the decision-making process on funding of new treatments. Distributional cost-effectiveness analysis (DCEA) is an extension of cost-effectiveness analysis that quantifies the equity impact of funding new treatments. Key challenges for the routine and consistent implementation of DCEA are the lack of clearly defined equity concerns from decision makers and endorsed measures to define equity subgroups and the availability of evidence that allows analysis of differences in data inputs associated with the equity characteristics of interest. In this article, we detail the data gaps and challenges to build robust DCEA analysis routinely in health technology assessment and suggest actions to overcome these hurdles. •Governments are putting greater focus on tackling health inequities, and health technology assessment bodies are responding by working to formally incorporate equity considerations into the decision-making process on funding of interventions.•Distributional cost-effectiveness analysis (DCEA) is a method to assess how health effects and costs are distributed between subpopulations and any ensuing trade-offs between maximizing overall population health and equity. DCEA provides a quantitative method for incorporating equity impact assessment into decision making.•Data gaps may limit the implementation of robust DCEA routinely for products undergoing health technology assessment. Therefore, data collection, analysis, and reporting need to be improved and aligned with the equity concepts of interest to decision makers.