The societal perspective in HTA: why it should matter.

Traditional health technology assessments (HTAs) primarily focus on safety, clinical effectiveness, and economic impact, typically through cost-effectiveness analyses conducted from the healthcare payer perspective using metrics such as cost per quality-adjusted life year. This approach overlooks the broader societal impacts of new health interventions and may lead to under- or overestimation of their overall value. Broadening the value framework to include the societal perspective would allow for the consideration of direct and indirect costs beyond health system costs, including lost productivity, caregiver impact, as well as the effect on other sectors such as education or welfare. Despite many HTA guidelines recommending its inclusion, few countries provide guidance on valuing non-health sector impacts or mandating the use of the societal perspective in the reference case. Although there are many challenges associated with the integration of the societal perspective into HTA evaluations, the lack of an internationally standardized context-specific framework remains the major barrier. Regional collaboration between HTA agencies to develop a societal perspective framework, build technical capacity, as well as share methodologies and data may address some challenges. Pilot studies should be encouraged to test the inclusion of societal elements, alongside the routine conduct of sensitivity analyses for evaluations undertaken from both healthcare sector and societal perspectives. This would enable policy makers to address uncertainty without compromising the core economic analysis. A broader, more flexible value framework may better align HTA with societal needs and values, and reward industry innovation while informing equitable funding decisions, capturing the full value of health technologies.