Abstract

Objectives

To study drug pricing in a reimbursement system accepting a higher cost per quality-adjusted life-year for drugs targeting conditions of higher severity. We investigate whether higher incremental cost-effectiveness ratios (ICERs) are observed for conditions of higher severity, how close to the highest acceptable cost-per-quality-adjusted life-year threshold drug prices are set, and whether the thresholds are applied as price ceilings. Furthermore, we explore factors other than severity that might affect pricing.

Methods

Disease severity and ICERs were extracted from publicly available reimbursement decisions made between 2017 and 2024 by the Swedish Dental and Pharmaceutical Benefits Agency. Linear regression assessed whether ICERs increase significantly with severity and other covariates and whether the same covariates explain deviations from the highest acceptable ICERs. We also assessed whether higher severity was associated with a higher likelihood of having confidential rebates in place.

Results

A total of 84 decisions reported ICERs and disease severity. ICERs increased significantly with severity (P .01).

Conclusions

Prices tend to be set below the reimbursement system’s thresholds and these appear to be ceilings, but decision makers should anticipate that drug companies will adjust prices in response to reimbursement policy, at least to some degree.