Presentation (CTI)

OBJECTIVES: The choice of perspective in health economic evaluations is fundamental. In Sweden, the Dental and Pharmaceutical Benefits Agency (TLV) determines which medicines should be reimbursed based on a health economic evaluation adopting a societal perspective. Broadly, this means that all relevant costs and benefits associated with a disease and treatment should be included. Since 2015, TLV uses a more restricted societal perspective excluding productivity losses because of the potential discrimination risk. This study aimed to examine how TLV assesses societal costs and applies the societal perspective in their evaluations.
METHODS: A structured search was conducted using the NMAi database, and metadata was used to filter all available TLV reimbursement decisions from 2022 to 2024. Selected decisions were manually reviewed to determine type of health economic analysis and whether societal costs were considered. Descriptive statistics were used to analyse the extracted data.
RESULTS: A total of 103 assessments were manually assessed. In nine (8.7%) of all the analysed assessments, the company included indirect costs in the base case analysis. TLV excluded the indirect costs in their base case analysis in all the assessments (9 [100%]). Interestingly, in one out of these nine assessments, TLV included productivity loss as an indirect cost in a sensitivity analysis. This resulted in the intervention being dominant towards the comparator.
CONCLUSIONS: Perspective choice in health economics evaluations has a great impact on the analysis results, and TLV recommends adopting a societal perspective. Here, how practice adheres with the TLV’s guidelines was examined. Although TLV accepts a societal perspective, excluding productivity losses, our results show that companies do not include societal costs but that TLV do not request or accept them either.