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Health Economics and Value Based
Pricing in Sweden
Jonathan Lind Martinsson
Deputy Head of Department
Department of Value Based Pricing, TLV
TLV is an agency under the Ministry
of Health and Social Affairs which:• Decides on the pricing and subsidising of
medicinal products and consumables
• Decides the regulation about the generic
substitution system
• Decides the pharmacy retail margin for subsidized
products
• Decides on the subsidizing of dental care
140 employees working with a multi-
disciplinary approach to
investigations, providing a broad
perspective.
The Market
Price index on-patent 2017
75 81 85 88 89 91 92 92 93 95 99 100 102 107 108 109 114 117 121 1380
20
40
60
80
100
120
140
160
Bil
ate
ralt
pri
sin
de
x S
ve
rig
e =
10
0
2017
2016
2015
2014
Sweden
stable in
the middle
Lowest
prices in
Poland &
Greece
Highest
prices in
Germany &
Switzerland
Prices off-patent (generics) 2018
100109 109
139 147165
184 184 192 193 201210
225 231246 249 255
267276
456
0
50
100
150
200
250
300
350
400
450
500
Ind
ex
bila
tera
lt -
Sve
rig
e =
10
0
Efficient
systems in
Sweden,
Denmark and
the
Netherlands
OECD expenditure on pharmaceuticals per capita for selected countries 2017
Pharmaceutical expenditure per capita
Source: OECD Health Data 2019
The System
Background: Pricing and reimbursement of
pharmaceuticals in Sweden
• TLV decides on pricing and reimbursement of
pharmaceuticals (EUR 2.8 billion per annum)
and regulates the generic substitution system
• 21 Regions provide health care. They have a
high degree of autonomy
• Pharmaceuticals used in in-patient care are
paid for in full by the regions
• The State finances the Regions’ expenses for
prescription pharmaceuticals that are covered
by the reimbursement system (TLV decides
on reimbursement)
Healt Economics is used for Value Based
PricingGoverning paragraph
• The cost of using the medicine should appear reasonable from medical, humanitarian and economic points of view
New treatment is compared with standard treatment
• Sub-groups
• Alternative treatments
Value for the money is measured by ICER
• Incremental cost-effectivness ratios
• Cost per quality adjusted life year (QALY)
Willingness-to-pay
• Severity of the disease
• Rare disease (if severe)
National recommendations and decisions
Decision to reimburse
if used
• Board of Pharmaceutical
Benefits (TLV)
– Members appointed by
the government
Recommendation to use
• The Council for New Therapies (NT)– Members appointed
by the regions
Hospital
PrescriptionDecisions to
use are made
by each region
New medicines
Patient access pathways and managed entry
Horizon
Scanning
(Regions,
TLV)
Decision national
managed entry
(NT-Council)
Request to
Sponsor
TLV
Health Economic
Evaluation
(TLV)
Recommendation
(NT-Council)
Introduction
(Regions)
Follow-up
(Regions,
TLV, Sponsors)
Submission to
TLV
(Sponsor)
Health Economic
Evaluation
(TLV)
Decision to
Reimburse
(TLV Board)
Two-party Negotiations
Procurement, Risk-sharing
(Regions, Sponsor)
Three-party Negotiations
Risk-sharing, Side Agreements
(Regions, Sponsor, TLV)
Hospital
Prescription
European co-
operation within
EUnetHTA increases
FINOSE:Finland
Norway
Sweden
Beneluxa:Netherlands
Belgium
Luxembourg
Austria
Ireland
FAAP:Hungary
Poland
Slovakia
Czechia
LatviaLa Valetta:Croatio
Cyprus
Greece
Ireland
Italy
Malta
Portugal
Romania
Slovenia
Spain
Inceased inflow of new technologies creates
need for development
✓ Rare diseases
✓ Biosimilars
✓ Antibiotics
✓ Oncology
✓ Diabetes
✓ Gene therapy
✓ Cell therapy
✓ Etc…
Rising costs,
increased
number of
introductions
expected
Strengthened
national
capacity to
learn from real
world evidence
Challenges for
specific types
of products
International
co-operation
Increased
interaction with
patients
National co-
operation with
the Regions
and providers a
key factorNeed for
development
The EndThank you for the
invitation and for
listening!
