New priorities – different decisions? How would the new prioritization guidelines proposed by the Norheim committee affect decision making when financing drugs in Norway?

Abstract Background: The set of prioritization criteria in the Norwegian health care is about to be changed again. This master thesis set forth to elaborate what would happen if some of the new proposed changes to prioritization suggested by the Norheim report replace the existing guidelines on decision-making in relation to the financing of drugs. Which types of drugs would or would not gain public reimbursement, and why? Methods: By looking at economic evaluations and decisions for six drugs, I try to show trends and consequences that might come as a result for future decisions by following some of the concrete suggested changes in the Norheim report. I investigate proposed changes to discounting, severity and thresholds. The reports produced by NoMA are detailed and by also accessing the underlying material for the analysis, I were able to make quite precise changes to former economic evaluations. Results: Based on the recalculation and reevaluation, I expected the recommendation of public financing of the drugs to change in one of the cases, and possibly change for two of the drugs, depending of interpretation and practical use of Norheim. Changing the discount rate from 4 % to 0 % for health effects reduced the ICER in all of the six cases. The analysis showed that when comparing the ranking of the six drugs in regards to severity, absolute shortfall was closer to health loss, than was proportional shortfall. Conclusions: By these six cases, I believe that changing from existing prioritization criteria and operationalization to Norheim’s proposals could have some implications. Whether these implications are desirable or not, needs to be debated