ISSUE: While the direct medical costs have been the primary or even sole focus of many Health Technology Assessments (HTAs), the inclusion of indirect costs and the adoption of a societal perspective in HTA is gaining momentum. However, it is still unclear if the societal perspective will become the new Reference Case, and if so how it could be implemented. Ulf Persson will present the rationale to consider societal perspective for Sweden, and Keith Tolley will discuss why the UK generally only considers direct costs in the base case. Ana Castro will cover the perspective of the cancer patient/physician/caregiver, as indirect costs are particularly relevant in oncology as most people diagnosed with cancer are working at the time of diagnosis. Patrick Hopkinson will moderate the discussion to ensure that differences between payer vs societal perspective are reflected in the learnings of the Issue Panel.
OVERVIEW: Sweden has been pioneering the inclusion of indirect costs in HTA and was joined later by Netherlands, Quebec and Taiwan. Recently, two influential groups/institutions have advocated the use of a societal perspective: the Second Panel on Cost-Effectiveness in Health and Medicine and EunetHTA guidelines. Also, the pharmaceutical industry has always been supporting the inclusion of societal perspective. Rival perspectives remain on who is the decision maker and who is the payer. Fundamental questions that remain are: Will restricted payer perspective lead to suboptimal decisions of resource allocation? How can we ensure that the broader impact on the patient is captured? Why valorize health gains from a societal perspective but not the cost? How does it influence equity? Is the societal perspective less comprehensive than is commonly assumed? This panel will debate on these questions and implementation considerations for making adoption of the Reference Case using a societal perspective the norm in HTA across the world.