The perspective of an economic
evaluation defines what types of benefit and cost are counted when
assessing the value for money of a health intervention. The health
sector perspective counts health outcomes and health system costs,
whereas a societal perspective includes effects relevant to other forms
of public expenditure, such as benefits to educational attainment or
economic productivity. This article describes how the National Institute
for Health and Care Excellence evaluated the arguments for and against
the adoption of a societal perspective and articulates the rationale for
its decision to retain a health sector perspective in its
value-for-money assessments but with flexibility to consider wider
societal effects when they are especially relevant to the value of a
health intervention.
The appropriate perspective to take is dependent upon the objective function of the payer. Under specific conditions, a publicly funded payer could optimize decision making across public sector budgets by adopting a full societal perspective. However, there are a range of ethical, practical, and methodological problems that arise when trying to implement a societal perspective. These include a lack of evidence on the opportunity cost of nonhealth outcomes to calculate net effects, no robust methodology to inform trade-offs between health and nonhealth sector outcomes, and the discriminatory consequences of counting productivity effects.
We discuss how these considerations are balanced against the need to consider the value of nonhealth effects during the technology evaluation and guideline production processes.
What is it about? The study examines different perspectives that can be used to evaluate the costs and benefits of health interventions, particularly focusing on the National Institute for Health and Care Excellence's (NICE) approach. This topic is crucial because it influences how healthcare interventions are valued, which can impact resource allocation decisions. The researchers addressed the issue of whether to adopt a broader societal perspective or a health sector perspective in health technology assessments (HTAs). The paper fills a gap by analyzing the arguments for and against a societal perspective, which considers wider impacts beyond direct health benefits. The article suggests that while including societal effects has some advantages, there were also notable disadvantages that led NICE to choose to maintain a health sector perspective, allowing flexibility for societal factors when particularly relevant. This study contributes to the ongoing debate about the best way to evaluate healthcare interventions to ensure they deliver value for money and improve population health.
How was the research conducted? The study's methodology is based on examining different perspectives in HTAs to understand their implications. This was applied by analyzing NICE's current practices and the arguments for and against different evaluation perspectives. The researchers reviewed existing guidelines and policies, focusing on the practical and ethical implications of adopting a societal perspective. The method involved a detailed analysis of the decision-making processes and the types of effects considered in health evaluations. The study primarily relied on a review of existing literature and guidelines and stakeholder workshops.
What were the results? The main finding of the study is that NICE decided to retain its health sector perspective in evaluating health interventions but will consider societal impacts when they are especially relevant. Additionally, the study identifies several methodological and ethical challenges when using a wider societal perspective, such as the difficulty of measuring nonhealth outcomes.
Why are the results important? These results are significant for HTA agencies because they highlight the importance of balancing comprehensive evaluations with practical considerations. The findings suggest that maintaining a health sector perspective allows for more efficient evaluations that still yield robust recommendations. Patients and healthcare providers benefit from clear guidelines that focus on improving health outcomes.
What are the strengths and weaknesses of this study? A strength of this study is its thorough analysis of the implications of different evaluation perspectives for HTA agencies. Future research could focus on developing more robust methods to measure societal effects and exploring their integration into health technology assessments to expand the understanding of their impacts.
Note: This content was created with assistance from artificial intelligence (AI) and has been reviewed and edited by ISPOR staff. For more information or for inquiries on ISPOR’s AI policy, click here or contact us at info@ispor.org.