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The impact of health economic evaluations in Sweden.

https://arctichealth.org/en/permalink/ahliterature266499
Source
Z Evid Fortbild Qual Gesundhwes. 2014;108(7):375-82
Publication Type
Article
Date
2014
Author
Emelie Heintz
Karl Arnberg
Lars-Åke Levin
Jan Liliemark
Thomas Davidson
Source
Z Evid Fortbild Qual Gesundhwes. 2014;108(7):375-82
Date
2014
Language
English
Publication Type
Article
Keywords
Cost-Benefit Analysis - economics
Cross-Cultural Comparison
Decision Making, Organizational
Delivery of Health Care - economics
Forecasting
Health Priorities - economics
Health Resources - economics - trends
Humans
Insurance, Dental - economics - trends
Insurance, Pharmaceutical Services - economics - trends
National Health Programs - economics
Reimbursement Mechanisms - economics - trends
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.
PubMed ID
25444295 View in PubMed
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The unintended (and costly) effects due to the introduction of an unrestricted reimbursement policy for atypical antipsychotic medications in a Canadian public prescription drug program: 1996/97 to 2005/06.

https://arctichealth.org/en/permalink/ahliterature150258
Source
Can J Clin Pharmacol. 2009;16(2):e346-59
Publication Type
Article
Date
2009
Author
Daria J O'Reilly
Ron A Goeree
Jean-Eric Tarride
Collen James
Patrick S Parfrey
Author Affiliation
Program for Assessment of Technology in Health (PATH) Research Institute, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada. oreilld@mcmaster.ca
Source
Can J Clin Pharmacol. 2009;16(2):e346-59
Date
2009
Language
English
Publication Type
Article
Keywords
Antipsychotic Agents - economics - therapeutic use
Databases, Factual
Drug Costs - trends
Health Expenditures - trends
Humans
Insurance Coverage - economics - trends
Insurance, Pharmaceutical Services - economics - trends
Newfoundland and Labrador
Reimbursement Mechanisms - economics - trends
Retrospective Studies
Abstract
Due to the increasing costs of pharmaceuticals, drug benefit programs often implement various policies that limit availability of drugs. These policies can have unforeseen consequences.
To examine the utilization and expenditures for antipsychotic medications in a provincial government community-based drug program over a 10-year period when atypical antipsychotics were introduced and multiple reimbursement policy changes with respect to these agents were employed.
Retrospective analysis of the Newfoundland and Labrador Prescription Drug Program (NLPDP) claims database from 1996/97 to 2005/06. Antipsychotic medication utilization and expenditure were measured and effects of changes in reimbursement policies examined. Excess expenditure was measured by subtracting the actual from modelled expenditure under different policies.
Between 1996/97 and 2005/06, the number of prescriptions for antipsychotic medications increased by 75% and expenditures by more than 720% to $7.2 million (peaking at $7.9 million in 2003/04), with atypical agents making up 96% of the total. Expenditure for antipsychotic medications grew by an annual average rate of 26.3%. At the same time, the number of people enrolled in the drug program declined by an annual average rate of 1.13%. The total excess amount of money spent was $266,195 per 1,000 beneficiaries during unlimited access to atypical agents.
There has been a substantial, unintentional, increase in the prescribing of atypical antipsychotics each year in Newfoundland and Labrador over the 10 years, likely due to off-label use following the unrestricted and partial restrictive access policies for these medications. Perhaps restricted access for recognized usage should be enforced.
PubMed ID
19531813 View in PubMed
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