Health technology assessment and screening in Sweden

Objectives: To describe health technology assessment (HTA) and policies con cerning three screening procedures in Sweden. Methods: The main source of information was reports from the Swedish Counci l for Technology Assessment in Health Care (SBU) and other governmental rep orts, supplemented by the professional literature. Results: Prevention is emphasized in the healthcare services of Sweden. Spe cifically, screening is encouraged and supported when it is deemed benefici al. Sweden has a strong orientation toward evidence-based health care and H TA. Since its inauguration in 1987, SBU has fostered the use of HTA in maki ng policy and clinical decisions in Sweden. Government policy in Sweden is to encourage services that are beneficial and cost-effective and discourage s services that are not. Screening is no exception to this general rule. Th e three cases examined in this paper-mammography screening, PSA screening, and routine ultrasound screening in pregnancy-have all been formally assess ed in Sweden. Assessments have been an integral part of policy making conce rning these and other preventive measures. Mammography screening has been w idely implemented. However, as in other countries, screening is often carri ed out in an opportunistic fashion, so that PSA screening, in particular, i s carried out more in Sweden than can be justified by the evidence. Conclusions: Mammography screening is promoted and is completely available to the target group. PSA screening is discouraged, but not with complete su ccess. Ultrasound in pregnancy is widely used, not because of good evidence of impact on mortality and morbidity among newborns, but because it increa ses the detection rate of congenitally malformed fetuses and because of evi dence of positive effects on the management and planning of deliveries, as well as because of psychological and ethical implications of the technology . HTA is an important part of health policy making in Sweden.