OBJECTIVES: To assess the quality of the health economic material submitted to the Swedish Pharmaceutical Benefits Board (PBB) as part of the application for reimbursement for new pharmaceuticals. The cost per QALY in the submitted material and how this has related to the PBB's decision is also presented. METHODS: The health economic evaluations were reviewed independently by two reviewers against two check lists, marking each question Yes/No/Not Applicable. The checklists used were: 1) The PBB Guidelines transformed into yes or no questions and 2) The QHES check list, which is a validated instrument. The central estimate, or base case, cost effectiveness was collected (preferably cost per QALY) as well as whether the application was accepted or rejected by the PBB. RESULTS: The scores on the PBB check list range from 0.24 to 0.87 and on the QHES from 0.09 to 1, with a mean quality of 0.61 and 0.67 respectively. Due to Swedish-specific criteria in the PBB list, there is only a modest correlation between the two instruments of 0.7. The baseline cost per QALY in the applications range from negative values (i.e. a cost-saving drug) to approximately 65,000 Euros. There was a low observed correlation between quality score and acceptance by the PBB. Likewise, the correlation between cost per QALY and decision to accept/reject is low or non-existent. CONCLUSIONS: 1) Health economic material as part of applications to PBB varies heavily in quality. 2) Due to the relatively small number of applications supported by substantial health economic evidence and the even fewer rejections, it is difficult to draw firm conclusions regarding the value the PBB places on a QALY.