Perspective

The ‘perspective’ is the point of view adopted in an economic evaluation when deciding which types of costs and health benefits to include. Typical perspectives are those of the patient, hospital/clinic, healthcare system 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, NICE recommends an ‘NHS and personal and social services’ perspective, 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. The NHS perspective includes treatment costs such as medicine costs, administration and monitoring, other health service resource use costs associated with 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.