Valeurs seuils pour le rapport coût-efficacité en soins de santé - KCE

48 ICER Thresholds KCE Reports 100
3.5.8 Finland hh
3.5.9 Sweden ii
• Another reason for not having a fixed ICER threshold value is that the
spending on community pharmaceuticals is required to be kept within a
fixed budget within a given year. Given the binding nature of this
constraint and all things being equal, what is and is not considered ‘costeffective’
varies with the amount of funding available (not just in terms of
the total budget each year, but the available budget at any point in time, as
explained in 2.5.3: a fixed budget requires a variable ICER threshold
value).
Pritchard et al. 93 speculated that PHARMAC’s decisions are broadly consistent with an
implicit threshold of NZ$20 000/QALY (NZ$ of the year 2000). The authors did not,
however, perform a systematic analysis of PHARMAC’s decision reports.
The Finnish ‘guidelines for preparing a health economic evaluation’ are published as an
annex to the Decree by the Ministry of Social Affairs and Health on applications for a
reasonable wholesale price, on special reimbursement status for a medicinal product,
and on the documentation to be attached to the application (decree 1111/2005).
Despite the formal requirement to provide health economic evaluations for new
chemical entities in Finland, we could not identify the use of any explicit ICER threshold
value, neither from the websites consulted (including the legislation of the institutions),
nor from the Finnish pharmacoeconomic guidelines.
In 2003, the Swedish Pharmaceutical Benefits Board published general guidelines for
conducting economic evaluations. 161 The English version of those guidelines does not
contain information about the use of an ICER threshold value for decision making.
The main task of the Pharmaceutical Benefits Board in Sweden is to ascertain if a
pharmaceutical or medical device is to be included in the pharmaceutical benefits
scheme and be reimbursed by society. The Pharmaceutical Benefits Board weighs three
criteria (‘principles’) when making its decisions:
• The human value principle; which underlines the respect for equality of all
human beings and the integrity of every individual.
• The need and solidarity principle; which says that those in greatest need
take precedence when it comes to reimbursing pharmaceuticals. In other
words, people with more severe diseases are prioritised over people with
less severe conditions.
• The cost-effectiveness principle; which states that the cost for using a
medicine should be reasonable from a medical, humanitarian and socialeconomic
perspective.
Cost-effectiveness thus appears to be a central concern in the Swedish reimbursement
system, 162 but a threshold value under which a treatment is considered cost-effective
does not appear to be explicitly stated. Other factors, besides cost-effectiveness, are
also weighed in the decision making process of the Pharmaceutical Benefit Board.
hh Websites consulted, accessed autumn 2008: the Finnish Office for Health Technology Assessment
(http://finohta.stakes.fi), the Finnish Ministry of Social Affairs and Health (http://www.stm.fi), the
Pharmaceuticals Pricing Board (the body responsible for pricing decision and operating under the control
of the Ministry of Social Affairs and Health), the Social Insurance Institution (the body responsible for the
reimbursement of pharmaceuticals, http://www.kela.fi).
ii Websites consulted, accessed autumn 2008: the Swedish Council on Technology Assessment in Health
Care (http://www.sbu.se), the Centre for Medical Technology Assessment (http://www.cmt.liu.se), the
Swedish Pharmaceutical Benefits Board (http://www.lfn.se/), the National Centre for Priority Setting in
Health Care (http://e.lio.se/prioriteringscentrum)