Step 4: Identify and Measure Specific Costs and Outcomes
All economic evaluations incorporate cost estimates. However, the perspective (e.g., societal or public payer) of the study defines the costs that should be included in the analysis. As the perspective of the study narrows, fewer costs will be included. For example, the societal perspective is the broadest perspective and captures all costs incurred to society from implementing an intervention. This includes the cost of medical care, cost of time in receiving care, formal caregiving cost, informal caregiving cost, transportation/other nonmedical cost, and administrative costs (Gold et al., 1996). In contrast, the payer perspective is much narrower and would include only the cost of covered services, and would not take into account any of the other costs (i.e., informal care, transportation). Regardless of the perspective, it is helpful to think of costs as multidimensional. That is, costs can come from various sources (e.g., the intervention, morbidity associated with disease, and side effects from treatment), and each source can have multiple types of costs (e.g., health care resources, non-health care resources, informal care resources) (Gold et al., 1996; Weinstein & Stason, 1977). Importantly, there are several theoretical debates about the inclusion of survivor and unrelated medical costs (Braithwaite, Meltzer, King, Leslie, & Roberts, 2008; Gold et al., 1996; Hunink & Glasziou, 2001; Meltzer, 1997; Nyman, 2004; Owens, Qaseem, Chou, & Shekelle, 2011). For practical purposes, most studies do not include survivor costs.