The term “perspective” of an economic evaluation is another word for the viewpoint adopted, which defines the type and character of costs and benefits to be considered. Invariably, the choice of perspective will be driven by the problem to be solved and will inevitably entail a full set of social value judgments. To be complete, an economic evaluation should address – or at the very minimum discuss – distributional consequences alongside optimum allocation issues. Unfortunately, distributional aspects (such as the impact of recommendations on grounds of “efficiency” on different groups of people, like the young versus the old, the healthy versus the severely sick, and so on) are rarely addressed in today’s reality of applied health economics.
Furthermore, health economists often discuss the appropriate perspective for evaluations in terms of costing, for example, whether costing should be undertaken from a societal or from a payers’ perspective. In contrast to the accounting definition of costs (i.e., outlay of funds), the distinguishing economic view of costs is that of “opportunity costs” (i.e., the value or benefit of the best alternative option forgone).
It appears therefore problematic to adopt different perspectives for costing and valuation, for example, by advocating to combine a measure of benefit capturing individual preferences for health states (such as health-adjusted life years) with a broader societal perspective on costs – in particular in the case of a national health scheme operating with a fixed health care budget. If, as in fact many academic guidelines for health economic evaluation recommend, a societal perspective was used for cost analysis, it would seem more consistent to adopt the maximum individual willingness-to-pay as a measure of value. This, however, is well-known to be a hard pill to swallow for many non-economists, as well as, arguably, the vast majority of health care policy makers.
The matter is further complicated by a host of observations supporting the suspicion that social value (in economic terms, “utility”) may differ from the simple aggregate of individual utility (or preferences), as it is conventionally assumed in mainstream economics. This might support the notion of a social perspective for the measurement of both costs and value, which has been rarely implemented in applied health economics, as it would imply a shift of the focus of analysis from the individual level (incremental cost per patient treated divided by incremental health gain of that patient) to the program level (i.e., net budget impact divided by the additional social value offered by the availability of a health technology).
In practice, InnoValHC analyses will carefully consider the implications of the choice of perspective for the interpretation of evaluation results. In many cases, it will be desirable to adopt more than one evaluation perspective, in order to fully inform stakeholders with heterogeneous interests and values about all relevant consequences of health care resource allocation decisions.