Reimbursement decisions for pharmaceuticals in Sweden : the impact of cost-effectiveness and disease severity

• Objectives: The purpose of this study is to evaluate the impact of cost-effectiveness and disease severity on the drug reimbursement decisions made by the reimbursement agency TLV in Sweden.Methods: Cost-effectiveness is measured through the continuous variable cost per QALY, while disease severity is measured by a dichotomous variable indicating high- or not high disease severity. We analyze all reimbursement decisions from 2005 through 2011 where there is data available on cost per QALY and disease severity. Logistic regressions are used to evaluate the impact of cost-effectiveness and disease severity on the drug reimbursement decisions.Results: There are 102 decisions with the required data available, 86 where reimbursement was granted and 16 where reimbursement was denied. The median cost per QALY for the drugs that were granted reimbursement was 39 000 euro (9sek/euro), ranging from a negative cost per QALY (better and cheaper) to 136 000 euro. The median cost per QALY for the drugs that were denied reimbursement was 111 000 euro, ranging from 78 000 euro to 1 111 000 euro. The results from the logistic regression analysis show that both the cost per QALY and the level of disease severity are statistically significantly related to the probability of a drug being granted reimbursement. When the cost per QALY exceeds 56 000 euro for non-severe diseases, and 92 000 euro for severe diseases, the probability that reimbursement is denied is higher than the probability that reimbursement is granted.Conclusions: In Sweden, it is sometimes stated as a rule of thumb that 55 000 euro per QALY is a threshold for cost-effective interventions. Our model shows that at this cost-effectiveness ratio, the probability of a new drug becoming reimbursed is 91 % or 98 %, depending on disease severity

Ämnesord

SAMHÄLLSVETENSKAP  -- Ekonomi och näringsliv (hsv//swe)

SOCIAL SCIENCES  -- Economics and Business (hsv//eng)

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