PHP118 Estimating the Probability of a Recommendation for Reimbursement for a New Drug in the UK Using an MCDA Approach

Abstract

OBJECTIVES: According to the Swedish Healthcare Act, any decisions for prioritisation in health care should be based on three principles; the principle of human dignity, the principle of need and solidarity, and the principle of cost-effectiveness. The principle of human dignity is superior to the two other principles and the cost-effectiveness principle is subordinate to the other two. The Swedish Dental and Pharmaceutical Benefits Agency (TLV) must prioritise accordingly when assessing whether a pharmaceutical should belong to the reimbursement system. This study aims to investigate the importance of economic evaluations in decisions for admission of pharmaceuticals to the reimbursement scheme. METHODS: A review of all TLV decisions regarding admission to the reimbursement system dated January 2011 to March 2012 was conducted. The information extracted included e.g. decision outcome, type of economic evaluation employed and considered medical need. Subsequently, the reasons behind the decisions were analysed. RESULTS: A total of 100 individual decisions for reimbursement were assessed. The vast majority of the 69 decisions leading to general reimbursement were made based on the result of an economic evaluation and a great medical need was the second most important reason. All of the eight negative decisions referred to the inability of the product to be considered a cost-effective alternative. The main reasons behind the 23 decisions for restricted reimbursement were a great medical need and that the product was cost-effective alternative for a specific subgroup.Hence, it appears that the principle for cost-effectiveness is considered more important than the principle of human dignity as medical need was the second most common reason for general reimbursement. CONCLUSIONS: The principle for cost-effectiveness appears to be the most important principle in decisions around a pharmaceutical's admission to the reimbursement system, although the principal's subordinate position to the principle of human dignity and the principle of need and solidarity.