> For the complete documentation index, see [llms.txt](https://ambitious-impact.gitbook.io/ambitious-impact-docs/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://ambitious-impact.gitbook.io/ambitious-impact-docs/ambitious-impact-eval/cost-effectiveness-modelling/adopting-a-perspective.md). # Adopting a perspective * Perspective, or point of view, defines the boundaries of the analysis. * Specifically, it notes what costs (and sometimes benefits) are accounted for within the analysis. * There is no established “right” perspective, but it is important to explictly state which one is being used. * Comparing analyses adopting different perspectives is difficult. If carrying out analysis across different interventions for comparative purposes, care should be taken to ensure that perspective is uniform across models. **Examples of perspectives** | **Cost** | **Patient / Service User** | **Payer (E.g, Philanthropic)** | **Provider** | **(Healthcare) Sector** | **(Health) System (WHO CHOICE)** | **Societal** | | ----------------------------------------------------------------------------------------- | -------------------------- | ------------------------------ | ------------ | ----------------------- | -------------------------------- | ------------------- | | **Direct service/healthcare costs borne by service user / patient (e.g., out of pocket)** | Yes | No | No | Yes | Yes | Yes | | **Direct costs incurred through use of service / healthcare (e.g., transport)** | Yes | No | No | No | No | Yes | | **Direct costs of provision / health care payer / provider** | No | Y (only payer) | Yes | Yes | Yes | Yes | | **Monetized productivity costs (e.g., from caregivers and and patients, farmers)** | Varies | No | No | No | No | Yes | | **Non-sector costs (e.g., spillovers on justice, education, etc.** | No | No | No | No | Varies | Varies (mostly yes) | ### **What perspective should I adopt?** * Adopting a societal perspective is the closest to a full accounting of costs and benefits. * However it is often impractical given how difficult it is to make an explicit account of all costs and benefits from an intervention from each possible actor. * Within prioritization research, where we are largely concerned with the destination of finite resources for social goods, we should aim to account for all direct costs, and some indirect ones. * To distinguish between capital that is spent by the payer(s) of an intervention, and costs incurred as a consequence of the payer/provider actions, we can account for the latter as disbenefits. * For instance, if a philanthropic direct cash transfer program provides USD 1,000 to beneficiaries, but beneficiaries need to pay USD 50 to access the cash transfer (ignore why this would be the case), then the USD 50 the beneficiary pays is counted as a negative effect on income, and the net effect on income is USD 950. **Suggested perspective for most prioritization research** | **Cost** | **Adapted payer perspective** | | ------------------------------------------------------------------------------------- | --------------------------------------------------------- | | Direct service/healthcare costs borne by service user / patient (e.g., out of pocket) | Dis-benefit | | Direct costs incurred through use of service / healthcare (e.g., transport) | Dis-benefit | | Direct costs of provision / health care payer / provider | Yes (inc. caused by the intervention for other providers) | | Monetized productivity costs (e.g., from caregivers and and patients, farmers) | Dis-benefit | | Non-sector costs (e.g., spillovers on justice, education, etc. | No | * Sometimes it may feel impractical or unimportant to account for dis-benefits in this way (e.g., where they are not expected to be substantial). That is okay, but you should make it clear that you opted not to, and provide an account of the reasons for your choices. * An intervention may also cause expenditure by other actors. For instance, a veterinary services demand generation intervention that advertises another non-profit’s free veterinary services can cause that non-profit to spend more money on its service provision. The costs of provision should be accounted for as part of provider costs, even if the payer in this case is only paying for demand generation. * You may value others’ money less than your own (e.g., you think your money buys more impact than a government’s money), this does not mean those incurred costs should not be accounted for - at best, you can discount the value of that money to reflect your valuing. * You will deal with specific line items in costing and effects soon, but for starters it is good to make your perspective explicit. ## **References** Sittimart, M., Rattanavipapong, W., Mirelman, A. J., Hung, T. M., Dabak, S., Downey, L. E., Jit, M., Teerawattananon, Y., & Turner, H. C. (2024). An overview of the perspectives used in health economic evaluations. *Cost Effectiveness and Resource Allocation*, *22*(1), 41. --- # Agent Instructions This documentation is published with GitBook. GitBook is the documentation platform designed so that both humans and AI agents can read, navigate, and reason over technical content effectively. Learn more at gitbook.com. ## Querying This Documentation If you need additional information that is not directly available in this page, you can query the documentation by asking a question. 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