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Perspective (pharmacoeconomic)

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Perspective in pharmacoeconomics refers to the economic vantage point that is being taken in a pharmacoeconomic analysis, such as a cost-effectiveness analysis or cost-utility analysis. This will affect the types of costs (resource expenditures) and benefits that will be considered relevant to the analysis.

Five general perspectives that are often cited in pharmacoeconomics include: institutional, third party, patient, governmental and societal. The author must state the perspective and then insure that costs and valuations remain consistent with it throughout the study.

If, for example, a pharmacoeconomic study is done from the institutional perspective, the medication cost would be relevant to the resource expenditures involved in the delivery of the therapy. Since the institution (e.g. hospital) incurs this expense, then it would be included. Other relevant costs might include: inventory carrying cost, pharmacy time to compound or dispense, nursing time to administer, disposables (e.g. medication cups or intraveous tubing) and even allocated hospital overhead costs.

The next component of perspective that needs to be addressed under perspective is valuation. Valuation defines the currency reference that will be used to represent the resource expenditure associated with a given cost. When it comes time to determine the actual "dollar amount" to be attributed to the medication, it needs to be consistent with the perspective as well. Average wholesaler price (AWP) might NOT be considered an appropriate valuation of medication cost from an institutional perspective, if it does not represent the true cost to the institution. Average acquisition cost would be more relevant as a medication cost valuation.

More complex perspectives may require broader stables of resource expenditures (costs) and more intricate valuations. For example, in the "societal" perspective, it is necessary for the author to consider additional costs that would not be relevant to a given institutional perspective. One such example includes "lost productivity". Lost wages from work due to illness would not be relevant to an insitutional perspective, since these do not represent expenditures an average institution (e.g. hospital) will incur. From a societal perspective, they would need to be included. Lost productivity due to illness has an impact on society at large and must therefore be included and properly valued.

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