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A comparative analysis of coverage decisions for outpatient pharmaceuticals: Evidence from Denmark, Norway and Sweden

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  • Grepstad, Mari
  • Kanavos, Panos

Abstract

This study analyses the reasons for differences and similarities in coverage recommendations for outpatient pharmaceuticals in Denmark, Norway and Sweden, following HTA appraisals. A comparative analysis of all outpatient drug appraisals carried out between January 2009 and December 2012, including an analysis of divergent coverage recommendations made by all three countries was performed. Agreement levels between HTA agencies were measured using kappa scores. Consultations with stakeholders in the three countries were carried out to complement the discussion on HTA processes and reimbursement outcomes. Nineteen outpatient drug-indication pairs appraised in each of the three countries were identified, of which 6 pairs (32%) had divergent coverage recommendations. An uneven distribution of coverage recommendations was observed, with the highest overlap in appraisals between Norway and Sweden (free-marginal kappa 0.89). Similarities were found in priority setting principles, mode of appraisal and reasoning for coverage recommendations. The study shows that health economic evaluation is less prominent or explicit in outpatient drug appraisals in Denmark than in Norway and Sweden, that all three countries could benefit from improved communication between appraisers and manufacturers, and that final coverage recommendations rely on factors other than safety, comparative efficacy or cost-effectiveness.

Suggested Citation

  • Grepstad, Mari & Kanavos, Panos, 2015. "A comparative analysis of coverage decisions for outpatient pharmaceuticals: Evidence from Denmark, Norway and Sweden," Health Policy, Elsevier, vol. 119(2), pages 203-211.
    • Handle: RePEc:eee:hepoli:v:119:y:2015:i:2:p:203-211
    DOI: 10.1016/j.healthpol.2014.12.013
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    References listed on IDEAS

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    1. Klingler, Corinna & Shah, Sara M.B. & Barron, Anthony J.G. & Wright, John S.F., 2013. "Regulatory space and the contextual mediation of common functional pressures: Analyzing the factors that led to the German Efficiency Frontier approach," Health Policy, Elsevier, vol. 109(3), pages 270-280.
    2. Michael Drummond, 2012. "Twenty Years of Using Economic Evaluations for Reimbursement Decisions. What Have We Achieved?," Working Papers 075cherp, Centre for Health Economics, University of York.
    3. Nicod, Elena & Kanavos, Panos, 2012. "Commonalities and differences in HTA outcomes: A comparative analysis of five countries and implications for coverage decisions," Health Policy, Elsevier, vol. 108(2), pages 167-177.
    Full references (including those not matched with items on IDEAS)

    Citations

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    Cited by:

    1. Maynou, Laia & Cairns, John, 2018. "What is driving HTA decision-making? Evidence from cancer drug reimbursement decisions from 6 European countries," LSE Research Online Documents on Economics 90877, London School of Economics and Political Science, LSE Library.
    2. Salas-Vega, Sebastian & Bertling, Annika & Mossialos, Elias, 2016. "A comparative study of drug listing recommendations and the decision-making process in Australia, the Netherlands, Sweden, and the UK," Health Policy, Elsevier, vol. 120(10), pages 1104-1114.
    3. Maynou, Laia & Cairns, John, 2019. "What is driving HTA decision-making? Evidence from cancer drug reimbursement decisions from 6 European countries," Health Policy, Elsevier, vol. 123(2), pages 130-139.
    4. Morgan, Steven G. & Daw, Jamie R. & Greyson, Devon & Shnier, Adrienne & Holbrook, Anne & Lexchin, Joel, 2020. "Variation in the prescription drugs covered by health systems across high-income countries: A review of and recommendations for the academic literature," Health Policy, Elsevier, vol. 124(3), pages 231-238.
    5. Fischer, Katharina Elisabeth & Heisser, Thomas & Stargardt, Tom, 2016. "Health benefit assessment of pharmaceuticals: An international comparison of decisions from Germany, England, Scotland and Australia," Health Policy, Elsevier, vol. 120(10), pages 1115-1122.

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