ECONOMIC-EVALUATION OF MEDICAL TECHNOLOGIES IN SWEDEN

This paper reviews the use of economic evaluations in the Swedish heal th care system. The most important actors are defined and examples are given how economic evaluations have played a role in the decision mak ing process. The introduction of extracorporal shock-wave lithotripsy (ESWL) is used as an example on how economic evaluation was used for r ecommendations to the county councils to adopt this technology. Mammog raphy is used as an example of how the evaluation is used in the polit ical process following an initiative in the parliament. A study of the cost-effectiveness of hypertension treatment illustrates how economic evaluations are included as part of a medical technology assessment b y SBU, the Swedish Council on Technology Assessment in Health Care. Th e role of economic evaluations for drug reimbursement and pricing is a lso reviewed. The main conclusions are that economic evaluations are o ne of several factors influencing a decision making process that have a strong strive for consensus. It is thus difficult to make a definiti ve statement of the contribution of such study to the outcome of the d ecision making process, and there is no evidence that the evaluation w as the decisive factor. However, a number of changes in the way resour ces are allocated in the Swedish health care system speaks for an incr easing role for such studies in the future. The county councils are id entified as the main target for economic evaluations, and SBU has a ke y role in supplying the county councils with high quality assessment o f new and old technologies. (C) 1997 Elsevier Science Ltd.