OBJECTIVES: Patient-centricity has become increasingly important in healthcare. This requires the patient’s perspective (PP) to be considered at all levels of decision making, ranging from coverage/reimbursement to clinical guideline development and shared healthcare decisions. In economic evaluations, different perspectives are reflected in the types of outcomes and costs considered. The objectives of this study are to understand whether and how PP has been incorporated in economic evaluations, to assess the need for more patient-centric economic models, and to propose a framework for better incorporating PP in economic evaluations.

METHODS: A targeted literature review of economic evaluations incorporating PP was performed. The key information on health outcomes and costs, the methods used to measure and value such parameters, and the decisions that the economic evaluations were intended to inform was extracted. Limitations of existing ways of incorporating PP and commentaries on how to fully reflect these were critically reviewed. A framework for better incorporating PP in economic evaluations was proposed.

RESULTS: Few economic evaluations included PP, and these were often grouped within a ‘societal’ perspective. Direct health benefits to patients, measured as life-years and quality-adjusted life-years are the most common outcomes estimated; other attributes were not considered, such as convenience, ease of use, or hope for patients and families. Direct medical costs were commonly included as relevant to patients, followed by direct non-medical and indirect costs. Intangible costs were rarely included. Average population or patient preferences were often used, with limited flexibility to account for patient heterogeneity. More patient-centric economic models are needed to reflect PP. An assessment framework using flexible model structures for better incorporating PP was developed.

CONCLUSIONS: PP can be and should be better incorporated in economic evaluations of health care. This will ensure better informed decision making at all levels of the health care system.