Ansgar Hebborn Hoffmann-La Roche, Basel, Switzerland

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1 How Should a Societal Perspective in Economic Evaluation be Implemented? Ansgar Hebborn Hoffmann-La Roche, Basel, Switzerland ISPOR Amsterdam, 11 November 2014 The need to take a societal perspective How to reflect the societal perspective in decision making?

2 Reliable and valid payer signals Essential driver of industry s R&D investments Industry s ability to deliver valuable health technology for areas of high unmet need Payer signals in terms of pricing and reimbursed access conditions reliably reflect societal preferences But how much is this the case? How specific are these signals with regards to the criteria that constitute value to patients, payers and society today and tomorrow? 3 HTA in different countries (national level) Diverging ideas about what constitutes value Sorenson, Drummond, Kanavos 2008 Ignoring key components of the wider societal impact of health care services increases the likelihood of mis-aligning public expectations towards the health care system and actual resource allocation (over- and under-investment into certain areas. 4

3 Taking a societal perspective in decision-making Key issues Territorial issues (health economics vs other disciplines) Societal perspective is not just a formal health economic concept Some consider it to be the universe of technology impacts (allocative, distributional etc) that a decision maker can take into account when allocating scarce health care resources Accountability issues In the absence of a clear obligation to take a societal perspective decision makers tend to take partial perspectives, ignoring impacts that go beyond a specific budgetary perspective impacts which are difficult to quantify with some degree of precision Methodological issues Handling of explicit and implicit distributional/ethical considerations in formal economic evaluation framework Other accounting/monetizing problems 5 The need to take a societal perspective How to reflect the societal perspective in decision making?

4 Taking the societal perspective The role of HTA health service researchers It is the public s money that is being spent and their health that is affected; perhaps as health service researchers, we should attempt to help decision-makers understand more fully what the public think and what their preferences are. Then, at least, decision-makers could act with knowledge of public views rather than in ignorance of them. What values do public want to see used in HTA? The questions, both substantive and methodological, are numerous but should not the health economic community begin systematically to build on the examples of the work to date? It is a fascinating and important area with some very significant implications for the relevance of current economic evaluations.

5 Societal perspective just a numbers game? The role of deliberation Devlin, Sussex Incorporating multiple criteria into HTA. OHE Integrating the societal perspective into health care decision making What it needs A politically legitimized decision maker/decision making body with an explicit mandate to take a societal perspective, corresponding governance framework and methodology A lot more respect from health economists for the size of the task given the inherent limitations of the own discipline Awareness for the considerable impact of the supply and demand side dynamics in a health care system on the effectiveness and costeffectiveness of technologies and related numerical estimates over time Unresolved issues in monetizing health care outcomes and their distribution, making it difficult for health economists to produce conclusive answers A deeper understanding on how to directionally improve a technology s effectiveness and cost-effectiveness over time i.e. the role of incentives and dis-incentives for patients, providers and others 10

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