OBJECTIVES: The perspective applied in Health Technology Assessment (HTA) has recently been presented as one of the areas of greatest methodological discussion in HTA. While healthcare technologies are expected to impact patients' health and quality-of-life, they can also impact other societal domains, like labor market and family. The methodology used to measure and value societal costs is a decisive factor in ensuring comparability between treatments when estimating their impact on society. This study aims to describe and summarize the current recommendations of HTA bodies on societal cost perspective’s adoption in HTA.

METHODS: An international pragmatic review of the HTA guidelines was performed and validated by HTA experts from the academic and industrial sectors through semi structured interviews. Guidelines of nine countries (Australia, Canada, France, Germany, Netherlands, Spain, Sweden, United Kingdom, United-States of America) were analyzed using a readiness grid divided into 4 categories: out-of-pocket-copayment costs, informal-care costs, productivity-losses & unrelated-health-care costs. Exploratory analyses determined whether the recommendation of a societal perspective as a base case was homogeneous for countries.

RESULTS: Societal perspective was recommended as a base case in 56% of the guidelines.11% of the guidelines discussed measurement methods for informal-care and productivity-losses. Only the Netherlands recommended a measurement tool for these societal societal costs (IPCQ). Most recommended valuation methods were opportunity cost (informal-care) and friction costs (productivity-losses). Educational-system and environmental costs were rarely discussed. There was a lack of homogeneity between the recommendations favoring the integration of societal costs and the HTA bodies ‘acceptance of the societal perspective as a base case.

CONCLUSIONS: This preliminary work highlights the need for HTA bodies to integrate explicit methodological recommendations on societal cost estimation. HTA bodies should learn from Netherland’s guidelines and cost database, and collectively (including patients and family) develop a societal perspective “doctrine”, by collecting the most impacting expenditure items and associated estimation methods.