Approximately 11 percent of Sweden’s GDP is currently spent on health care. These costs have increased over time, both in absolute terms and as a proportion of the total economy. Nevertheless, there are frequent reports regarding queues, a lack of resources and difficulties in terms of financing new treatments. Questions concerning priority setting are thus becoming increasingly important. Hence, the report examines whether the current priority setting processes in health care ensure that what is introduced offers true patient benefits with a reasonable cost-effectiveness. The report highlights that in far too many cases, new interventions are introduced at a high cost but without sufficient patient benefits.
Results and conclusions
- In the orderly introduction of new health care interventions, priority setting should be based on the three principles of the so-called ethical platform: the human dignity principle, the needs and solidarity principle and the cost-effectiveness principle.
- In order to prioritize based on the ethical platform, we need evidence-based knowledge regarding the costs and patient benefits of various interventions. Such knowledge, however, is frequently lacking when new interventions are implemented in the health care system.
- In Sweden and internationally, research literature has shown that a large amount of resources is spent on interventions offering no or very limited patient benefits. The report presents examples of this in the areas of pharmaceutical treatments, surgery and medical technology.
- There are many explanations why costly interventions with limited or no patient benefits are introduced and implemented in the health care system. One explanation is that decision-makers and health care workers regularly make overly optimistic assumptions concerning the benefits of interventions based on unreliable and inadequate data. Requirements in terms of proven patient benefits and cost-effectiveness have also been lowered in several areas over time.
- Strengthen the requirements regarding scientific evidence and follow-up for ordered implementations: interventions should not be implemented unless there is well-documented evidence or best practices demonstrating that they clearly benefit patients while being reasonably cost-effective.
- Expand the use of not-to-do lists: The documentation by the Swedish National Board of Health and Welfare concerning interventions that should be eliminated from the health care system altogether or not performed on a regular basis (not-to-do lists) should be developed further and linked to open comparisons, thus enabling the monitoring of how often such interventions are carried out at the regional and hospital levels. This may contribute to health care interventions offering little or no value being selected to a lesser extent.
- Revise the cost-effectiveness threshold: the cost of each realized healthy life year due to a new intervention is often used as an indicator of its cost-effectiveness. However, we know next to nothing concerning how to specify this threshold and how it affects the overall cost-effectiveness of the health care system. There need to be requirements regarding cost-effectiveness so that newly introduced treatments are not prioritized over existing treatments actually offering more patient benefits in relation to the limited budget of the health care system.
- Strengthen the health care system as a knowledge-based organization: a strong knowledge-based organization is a prerequisite for ensuring that health care resources are spent on interventions for patients with the greatest needs while also offering the greatest patient benefits. Improve the conditions and strengthen the incentives for health care workers engaged in research, while also increasing the requirements concerning methodology training in PhD programs in medicine and health sciences in order to raise awareness regarding how to assess scientific evidence and the quality of scientific studies.
Mikael Svensson is Professor in Applied Health Economics at the University of Gothenburg.