ISSUE: There is ongoing debate regarding how to develop economic evaluations that meet the needs of healthcare payors (including employers), patients and caregivers, as well as members of society who may become patients, but are also struggling with ever-increasing insurance premiums. During this issue panel, we will debate the potential merits of an “insured member unit” and “patient-informed” reference cases.

OVERVIEW: Reference cases are intended to improve consistency and comparability across cost-effectiveness analyses (CEA). Current best practices recommend presenting healthsector- and societal-perspective reference cases alongside one another. The health sector perspective is criticized as too narrow and insufficiently reflecting costs incurred by patients and their families. Although the societal reference case is praised for including many costs important to employers, patients, and their caregivers, it is also criticized as impractical because it includes costs that are hard to quantify and potentially irrelevant for informing healthcare payer decisions (e.g., criminal justice, environment). As a result, most CEAs do not take a societal perspective. Among those that do take a societal perspective, many impacts recommended by the Second Panel on CEA are omitted. This inconsistency limits comparisons across CEAs and has been criticized by healthcare stakeholders, especially members of the patient community.