Heintz Emelie, Arnberg Karl, Levin Lars-Åke, Liliemark Jan, Davidson Thomas
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.
The Dental and Pharmaceutical Benefits Agency (TLV), Stockholm, Sweden.
Z Evid Fortbild Qual Gesundhwes. 2014;108(7):375-82. doi: 10.1016/j.zefq.2014.09.006. Epub 2014 Sep 23.
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.
瑞典的医疗保健责任由中央政府、郡议会和市政府共同承担。郡和市在国家医疗保健法律框架内可自行确定优先事项。为指导瑞典医疗保健资源的优先排序，人们达成共识，成本效益是三项原则之一。本文旨在描述成本效益以及健康经济评估（HEE）如何在瑞典医疗保健系统的定价决策、药品报销以及资源的总体优先排序和分配中发挥作用。瑞典医疗保健系统中有多个组织参与健康技术的实施过程，其中一些组织在评估不同技术时会考虑或进行健康经济评估：牙科和药品福利局（TLV）、郡议会新药疗法小组（NLT）、国家卫生和福利委员会、瑞典卫生技术评估委员会（SBU）、地区卫生技术评估机构以及瑞典公共卫生署。唯一拥有关于如何进行健康经济评估的官方和强制性指南的政府机构是TLV（LFNAR 2003:2）。尽管健康经济评估在瑞典医疗保健系统的决策过程中似乎有着明确和显著的作用，但在结果的使用和传播方面存在各种障碍和挑战。
