title: Reimbursement Decisions for Pharmaceuticals in Sweden: The Impact of Disease Severity and Cost Effectiveness.
abstract: OBJECTIVE
  The Swedish Dental and Pharmaceutical Benefits Agency (TLV) is the government body responsible for deciding whether outpatient drugs are to be included in the pharmaceutical benefits scheme. This paper analyzes the impact of cost effectiveness and severity of disease on reimbursement decisions for new pharmaceuticals.
  
  
  METHODS
  Data has been extracted from all decisions made by the TLV between 2005 and 2011. Cost effectiveness is measured as the cost per quality-adjusted life-year (QALY) gained, whereas disease severity is a binary variable (severe-not severe). In total, the dataset consists of 102 decisions, with 86 approved and 16 declined reimbursements.
  
  
  RESULTS
  The lowest cost per QALY of declined reimbursements is Swedish kronor (SEK) 700,000 (€ 79,100), while the highest cost per QALY of approved reimbursements is SEK1,220,000 (€ 135,600). At a cost per QALY of SEK702,000 Swedish kronor (non-severe diseases) and SEK988,000 (severe diseases), the likelihood of approval is estimated to be 50/50 (€ 79,400 and € 111,700).
  
  
  CONCLUSIONS
  The TLV places substantial weight on both the cost effectiveness and the severity of disease in reimbursement decisions, and the implied willingness to pay for a QALY is higher than the often cited 'rule of thumb' in Swedish policy debates.
authors.affiliation: Department of Economics, Örebro University, Fakultetsgatan 1, 701 82, Örebro, Sweden. mikael.svensson@oru.se.
authors.forename: Mikael
authors.initials: M
authors.lastname: Svensson
authors.affiliation: The Dental and Pharmaceutical Benefits Agency (TLV), Stockholm, Sweden.
authors.forename: Fredrik O L
authors.initials: FO
authors.lastname: Nilsson
authors.affiliation: The Dental and Pharmaceutical Benefits Agency (TLV), Stockholm, Sweden.
authors.forename: Karl
authors.initials: K
authors.lastname: Arnberg
mesh_terms: D003657:Decision Making; D017850:Economics, Pharmaceutical / Q000458:organization & administration*; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D012720:Severity of Illness Index; D013222:State Medicine / Q000191:economics*; D013548:Sweden