OBJECTIVES: Adoption of the societal perspective in economic evaluations of health care technologies has been encouraged by health economists and health technology assessment bodies. The societal perspective differs from the conventional payer perspective in its inclusion of non-payer costs that are relevant to the greater societal system. This targeted literature review aimed to investigate non-payer costing approaches in oncology cost-effectiveness analyses (CEAs).

METHODS: A search was conducted in PubMed/Medline in November 2022 to characterize non-payer costs within societal CEAs evaluating oncology treatments in the United States (US), Canada, Australia, and the European Union.

RESULTS: Of 587 records screened, 47 studies were included, with 29 US and 18 non-US studies. Most studies provided little detail on non-payer costing methods beyond identification of cost types. Non-payer cost categories included were highly variable. 57%, 49%, and 32% of studies reported productivity loss, patient travel, and caregiver costs, respectively. Among studies that provided detail on productivity loss costing methods, various methods were represented. Despite many studies’ inclusion of only a narrow set of non-payer costs, authors tended to maintain use of the descriptor “societal” rather than “limited societal” perspective. 30% of studies reported both payer and societal perspective results. The incremental cost-effectiveness ratio (ICER) in the societal perspective was within +/-20% of the payer perspective ICER in 43% of studies that included both perspectives. Non-payer cost inputs were not routinely subject to sensitivity analyses. Where they were included in sensitivity analyses, these inputs were rarely identified as an influential parameter.

CONCLUSIONS: Societal-perspective oncology CEAs contain a diverse range of non-payer costs. Methodologies used to model these costs are not standardized. While recent attention in oncology modeling has focused on non-traditional value elements, this targeted review suggests a possible gap in the rigor and transparency in reporting the methodology behind non-payer costing.