Three perspectives are most commonly used in economic evaluations in the healthcare sector:
(1) the payer perspective, which includes only the costs and utility of a particular party such as the patient, employer, or insurer; (2) the health care perspective, which includes only the costs and utility within the health care sector; and last but not least, (3) the societal perspective, in which the analyst considers all costs and utility that result from the intervention, regardless of who experiences them (Drost et al. 2017).
This definition of the societal perspective is quite common and accepted, but it does not give a full sense of what it encompasses, beyond the fact that it includes ‘everything’.
The review by Drost el. (2017) summarizes that societal costs can include in particular:
- The costs of the intervention
- Health care costs
- Cost to the patient and family
- Costs related to loss of productivity
- Costs in other areas (household and informal care costs, costs of volunteer and leisure work, and costs to the law enforcement and justice system)
However, authors state that their results suggest that the ways in which the societal perspective is conceptualised and implemented within health economic evaluations vary considerably. As a result, there is great diversity in the types of costs included in the analyses within the published studies (Drost et al. 2017).
One may also ask what types of analyses are included in the analyses of societal perspectives. According to the above-mentioned authors, these are mainly cost-utility studies, i.e. the studies evaluating costs and utility, followed by cost-effectiveness analyses, while in other types of studies this perspective also occurs, but significantly less frequently. In terms of the period evaluated, most studies either calculate the length of one year, or quantify these costs over the lifetime.
In summary, the authors of individual studies do not agree on what costs to include in this dimension of the evaluation, nor on how to quantify them, for example in terms of the cost of lost productivity. On the other hand, the inclusion and quantification of costs has a major impact on the result of the analysis. It is perhaps not without interest that this perspective is one that many papers that deal with it discuss extensively in the limitations of their work, i.e. the necessary degree of certainty is lacking. This provides an opportunity for authors in each country to specify their understanding of the societal perspective and how they quantify costs in each area.
So far, this text has rather summarized some comments on why this assessment is difficult; let us now look at why this assessment is appropriate or necessary. That reason is that omitting this perspective leads to inaccurate results from, for example, ICER or ICUR or other very important economic outputs, and then also to making even less optimal decisions when choosing different types of interventions. For example, if we omit the costs of lost productivity or the costs of the social protection system, some care may quite undeservedly appear cheaper than it is, given that many of the costs will be incurred, perhaps even in the long run, outside the health sector itself.
As noted in (Drost et al. 2017), the way in which the societal perspective is conceptualised and implemented in economic evaluations is partly dependent on national economic evaluation guidelines. In the Czech Republic, a clear guideline does not exist at this time, however, societal costs are evaluated in some studies. Within the CzechHTA group, for example, a study that focused on the societal costs of elder abuse and neglect in the capital city of Prague (Haunerová, Barták, Rogalewicz & Kuchař, 2017).
In the preparation of any economic analysis in the healthcare sector, it is advisable and, in fact, inevitable to use the widespread standards known under the acronym CHEERS, Consolidated Health Economic Evaluation Reporting Standards. Since January 2022, the Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) are available (Husereau et al. 2022).
Sources:
Drost, R., Van der Putten, I., Ruwaard, D., Evers, S., & Paulus, A. (2017). CONCEPTUALIZATIONS OF THE SOCIETAL PERSPECTIVE WITHIN ECONOMIC EVALUATIONS: A SYSTEMATIC REVIEW. International Journal of Technology Assessment in Health Care, 33(2), 251-260. doi:10.1017/S0266462317000526
Husereau, D., Drummond, M., Augustovski, F. et al. Consolidated Health Economic Evaluation Reporting Standards 2022 (CHEERS 2022) statement: updated reporting guidance for health economic evaluations. BMC Med 20, 23 (2022). https://doi.org/10.1186/s12916-021-02204-0