The perspective is the point of view adopted when deciding which types of costs and health benefits should be included in an economic evaluation. Typical viewpoints are those of the patient, hospital/clinic, healthcare, social services, broader publicly-funded services or society. The broadest perspective is societal, which reflects a full range of social opportunity costs associated with different interventions. In particular, this includes productivity losses arising from patients’ inability to work and changes in these losses associated with a new therapy. In its reference case, The National Institute for Health and Care Excellence (NICE)
recommends a perspective of ‘NHS and personal and social services’, recognising that the societal perspective may bias against those not in work, such as people over retirement age or those not able to work due to health reasons. For example, the NHS perspective includes treatment costs such as medicine costs, administration and monitoring, other health service resource use costs associated with the managing the disease (e.g. GP visits, hospital admissions), and costs of managing adverse events caused by treatment. It does not include patients’ costs of obtaining care such as transportation, over the-counter purchases, co-payments or time off work. For NICE’s perspective on health outcomes, quality adjusted life years (QALYs) are based on the general population’s valuation of health outcomes (obtained through surveys), and not patients own valuations of their health states. In economic evaluations of care services for adults, The EuroQol five dimension (EQ-5D) is increasingly replaced by additional utility measures with a broader perspective than health-related quality of life. For examples, see ICEpop CAPability measure for Older people (ICECAP-O) and the Adult Social Care Outcomes Toolkit (ASCOT).
NIHR School for
Social Care Research