The role of economic evaluations in health care decision making

Increasing health care expenditures, a rapid introduction of new medical technologies and a need for cost containment policies in most countries during the last decades have led to a growing interest in information from economic evaluations for decision making about resource allocation in health care. Economic evaluations can provide valuable information in many types of decision making, e.g. related to the use of drugs, other health care interventions/programs and investments in new technologies or research. These are, however, currently most widely used in pricing and reimbursement decisions for new drugs, in health technology assessment and for development of guidelines for prevention and treatment. This thesis discusses the role of economic evaluations in different types of health care decision making concerning resource allocation. Two of the studies analyse the available costeffectiveness evidence for new drugs. The other four studies discuss and provide costeffectiveness information to be used in the following important types of decision making situations in Sweden: reimbursement of new drugs, investments in new technology, implementation of screening programs and choices between therapies. The publication of economic evaluations increased dramatically during the 1980's and 1990's. This thesis demonstrates that economic evaluations during the 1990's were more likely to be conducted for drugs with improved effectiveness or safety as compared to those of the competitors and for drugs with high sales. Although requirements for economic evaluations for reimbursement decisions may lead to a more cost-effective use of the resources, it is important to recognise that regulations also involve a cost. Increasing requirements for cost-effectiveness in Sweden and Finland may have been associated with a delayed introduction of new drugs on the market, at least the first year after the changed regulations. However, it cannot be ruled out that the observed data might be due to chance or adaptations in the timing of new drug introductions. This thesis discusses four types of decision making where cost-effectiveness information can be of value for the decisions. The four economic evaluations identified patient populations and indications where teriparatide treatment for osteoporosis, proton radiation for breast cancer, screening for abdominal aortic aneurysm in men and use of iodixanol in angiography may be considered cost-effective in Sweden