title: The impact of health economic evaluations in Sweden.
abstract: The responsibility for healthcare in Sweden is shared by the central government, county councils and municipalities. The counties and municipalities are free to make their own prioritizations within the framework of the state healthcare laws. To guide prioritization of healthcare resources in Sweden, there is consensus that cost-effectiveness constitutes one of the three principles. The objective of this paper is to describe how cost-effectiveness, and hence health economic evaluations (HEE), have a role in pricing decisions, reimbursement of pharmaceuticals as well as the overall prioritization and allocation of resources in the Swedish healthcare system. There are various organizations involved in the processes of implementing health technologies in the Swedish healthcare system, several of which consider or produce HEEs when assessing different technologies: the Dental and Pharmaceutical Benefits Agency (TLV), the county councils' group on new drug therapies (NLT), the National Board of Health and Welfare, the Swedish Council on Health Technology Assessment (SBU), regional HTA agencies and the Public Health Agency of Sweden. The only governmental agency that has official and mandatory guidelines for how to perform HEE is TLV (LFNAR 2003:2). Even though HEEs may seem to have a clear and explicit role in the decision-making processes in the Swedish healthcare system, there are various obstacles and challenges in the use and dissemination of the results.
authors.affiliation: Swedish Council on Health Technology Assessment (SBU), Stockholm, Sweden; Center for Medical Technology Assessment (CMT), Department of Medical and Health Sciences, Linköping University. Linköping, Sweden. Electronic address: Emelie.Heintz@sbu.se.
authors.forename: Emelie
authors.initials: E
authors.lastname: Heintz
authors.affiliation: The Dental and Pharmaceutical Benefits Agency (TLV), Stockholm, Sweden.
authors.forename: Karl
authors.initials: K
authors.lastname: Arnberg
authors.affiliation: Center for Medical Technology Assessment (CMT), Department of Medical and Health Sciences, Linköping University. Linköping, Sweden.
authors.forename: Lars-Åke
authors.initials: LÅ
authors.lastname: Levin
authors.affiliation: Swedish Council on Health Technology Assessment (SBU), Stockholm, Sweden; The county councils' group on new drug therapies (NLT), The Swedish Association of Local Authorities and Regions (SALAR), Stockholm, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Liliemark
authors.affiliation: Swedish Council on Health Technology Assessment (SBU), Stockholm, Sweden; Center for Medical Technology Assessment (CMT), Department of Medical and Health Sciences, Linköping University. Linköping, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Davidson
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics*; D003431:Cross-Cultural Comparison; D003659:Decision Making, Organizational; D003695:Delivery of Health Care / Q000191:economics*; D005544:Forecasting; D006292:Health Priorities / Q000191:economics; D006295:Health Resources / Q000191:economics / Q000639:trends; D006801:Humans; D007347:Insurance, Dental / Q000191:economics / Q000639:trends; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000639:trends; D009313:National Health Programs / Q000191:economics*; D012051:Reimbursement Mechanisms / Q000191:economics / Q000639:trends; D013548:Sweden
keywords: Erstattungssystem; Kosten-Nutzen-Bewertung; Preisbildung; Reimbursement; Schweden; Sweden; health economic evaluation; pricing