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Willingness to Pay for Different Severity Levels in Sweden: An Analysis of TLV Decisions (2014-2022)

Speaker(s)

Viollet J, O'Leary E, Camacho Gonzalez C, Lauppe R, Oldsberg L
Quantify Research AB, Stockholm, Sweden

Presentation Documents

OBJECTIVES:

The Swedish Dental and Pharmaceutical Benefits Agency (TLV) decides on the reimbursement of outpatient drugs. TLV’s willingness to pay (WTP) is based on the severity level of the indication. The objective was to determine which WTP thresholds TLV followed in practice and whether they had evolved over time.

METHODS:

Data was collected from decisions made between January 2014 and June 2022 that include a base case ICER by TLV. Variables extracted included product-specific information, severity, TLV’s ICER and reimbursement outcome for the ICER population (full reimbursement, reimbursement for subpopulation, limited to indication assessed, not reimbursed).

RESULTS:

101 decisions (31% general subsidy, 55% limited subsidy and 14% declined) were collected, including 137 base case ICERs calculated by TLV. For the low severity, 0% of indications were fully reimbursed, 14% got subpopulation reimbursement, 0% were limited to the indication assessed and 86% were not reimbursed. For medium, these values were 25%, 55%, 13% and 8% respectively. For high, 33%, 43%, 0% and 23%. For very high, 39%, 29%, 20% and 12%.

Regarding WTP for products that are reimbursed, the only ICER found for low severity was around 120,000SEK, the average ICER for medium severity around 270,000SEK (maximum accepted: 570,000SEK), 470,000SEK for high (maximum accepted: 750,000SEK) and 780,000SEK for very high (maximum accepted without mention of higher WTP than usual: 1,000,000SEK). Average WTP per severity has been stable since 2016. For rejected reimbursements, the minimum ICERs were 230,000SEK for low severity, 680,000SEK for medium, 890,000SEK for high and 1,030,000SEK for very high.

CONCLUSIONS:

TLV’s base case ICERs point to severity WTP thresholds around 200,000SEK for low severity, 600,000SEK for medium, 750,000SEK for high and 1,000,000SEK for very high. These results suggest that the WTP thresholds applied in practice are largely aligned with the unofficial, but often referred to WTP thresholds of 250,000SEK, 500,000SEK, 750,000SEK and 1,000,000SEK.

Code

HTA228

Topic

Economic Evaluation, Health Technology Assessment

Topic Subcategory

Cost-comparison, Effectiveness, Utility, Benefit Analysis, Decision & Deliberative Processes, Thresholds & Opportunity Cost, Value Frameworks & Dossier Format

Disease

No Additional Disease & Conditions/Specialized Treatment Areas