Time horizon

 In Time horizon, the time span for which costs and effects (consequences) should be measured or estimated is defined. Typically, a patient lifetime horizon is used, but other time horizons are possible, e.g., an observation time of a population or even an extrapolation to future generations.

Perspective

The chosen perspective of an economic evaluation is a key element in defining which costs and consequences are to be included in the analysis. 

Perspectives can be from:

  • a health service (all costs and outcomes related to the health care sector are included)
  • society (where all relevant costs and outcomes of the technologies have to be identified, measured and valued, no matter who pays these costs and consequences)
  • an organization or institution, such as a hospital
  • individual patients
  • the target group for a specific technology. 

Using a standard approach

Given the potential for variation, it is essential, within a high-quality assessment, that the rationale behind cost estimate and health outcomes and the sources of data used to assess these are clearly documented.

Many health systems have developed guidance for economic evaluation. This avoids a situation where an evaluation of one technology looks more attractive than another simply because the analyst used different underlying assumptions and approaches during the assessment.

A database of such guidelines is currently maintained by the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) ISPOR - PE Guideline Detail. The European Network for Health Technology Assessment (EUnetHTA) has published a guideline ’Methods for health economic evaluations - A guideline based on current practices in Europe’ representing a consolidated view of non-binding recommendations of EUnetHTA network members on current practices in the EU[1]. Despite the availability of these guidelines, many are often not properly adhered to. This can lead to inconsistent or overly favourable or overly negative findings in some cases.in the EU[2].

Shape[1]EUnetHTA 2015, https://eunethta.eu/wp-content/uploads/2018/03/Methods_for_health_economic_evaluations.pdf