Use of Cost-Effectiveness Data in Priority Setting Decisions: Experiences from the National Guidelines for Heart Diseases in Sweden

Document Type : Original Article

Authors

1 Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden

2 Department of Cardiology and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden

Abstract

Background
The inclusion of cost-effectiveness data, as a basis for priority setting rankings, is a distinguishing feature in the formulation of the Swedish national guidelines. Guidelines are generated with the direct intent to influence health policy and support decisions about the efficient allocation of scarce healthcare resources. Certain medical conditions may be given higher priority rankings i.e. given more resources than others, depending on how serious the medical condition is. This study investigated how a decision-making group, the Priority Setting Group (PSG), used cost-effectiveness data in ranking priority setting decisions in the national guidelines for heart diseases.
 

Methods
A qualitative case study methodology was used to explore the use of such data in ranking priority setting healthcare decisions. The study addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. We were also interested in the explicit use of data in ranking decisions, especially in situations where economic arguments impacted the reasoning behind the decisions.
 
Results
This study showed that cost-effectiveness data was an important and integrated part of the decision-making process. Involvement of a health economist and reliance on the data facilitated the use of cost-effectiveness data. Economic arguments were used both as a fine-tuning instrument and a counterweight for dichotomization. Cost-effectiveness data were used when the overall evidence base was weak and the decision-makers had trouble making decisions due to lack of clinical evidence and in times of uncertainty. Cost-effectiveness data were also used for decisions on the introduction of new expensive medical technologies.
 

Conclusion
Cost-effectiveness data matters in decision-making processes and the results of this study could be applicable to other jurisdictions where health economics is implemented in decision-making. This study contributes to knowledge on how cost-effectiveness data is used in actual decision-making, to ensure that the decisions are offered on equal terms and that patients receive medical care according their needs in order achieve maximum benefit.

Highlights

Commentaries Published on this Paper

  • Lonely at the Top and Stuck in the Middle? The Ongoing Challenge of Using Cost-Effectiveness Information in Priority Setting; Comment on “Use of Cost-Effectiveness Data in Priority Setting Decisions: Experiences from the National Guidelines for Heart Diseases in Sweden”          

            Abstract | PDF

  • The Use (or rather the non-Use) of Cost-Effectiveness Data in Priority Setting Decisions – Are We Underestimating the Barriers to Using Health Economics in Real World Priority Setting Decisions?; Comment on “Use of Cost-Effectiveness Data in Priority Setting Decisions: Experiences from the National Guidelines for Heart Diseases in Sweden”

            Abstract | PDF

  • Incorporating Cost-Effectiveness Data in a Fair Process for Priority Setting Efforts; Comment on “Use of Cost-Effectiveness Data in Priority Setting Decisions: Experiences from the National Guidelines for Heart Diseases in Sweden”

            Abstract | PDF

 

Authors' Response to the Commentaries

  • Including Both Costs and Effects – The Challenge of Using Cost-Effectiveness Data in National-Level Policy-Making: A Response to Recent Commentaries

            Abstract | PDF

Keywords

Main Subjects

References

 
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History

  • Receive Date: 02 July 2014
  • Revise Date: 22 October 2014
  • Accept Date: 22 October 2014
  • First Publish Date: 01 November 2014

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