ISSUE: The perspective of an economic evaluation determines which types of outcomes are counted in cost-benefit calculations. Health technology assessment (HTA) agencies typically define a reference case perspective that is applied across assessments to ensure consistency and fairness. Whilst some agencies specify a health sector perspective for their health economic analyses, which counts health outcomes and healthcare costs, others have opted for a societal perspective that includes additional effects, the most common being the impacts on economic productivity.

Proponents of a societal perspective argue that a health sector perspective misses important relevant effects and can lead to HTA agencies not recommending treatments that have positive net social effects. Conversely, a broader perspective raises a different set of practical, methodological and ethical issues relating to the consistency, transparency and robustness of economic assessments. These include determining which aspects of benefit and cost should be included, how they should be valued and concerns about the quality of supporting evidence. In recent years, several HTA agencies have reviewed, and in some cases changed, their approach to perspective in light of these challenges.

OVERVIEW: The moderator will begin the session with a brief introduction and update on NICE’s recent review of its approach to perspective (5 mins). The panel will then explore the key issues around the choice of perspective and provide insights on whether and how a societal perspective should be implemented within HTA (10 mins per panellist). The session will conclude with an open discussion with the audience (20 mins).