Discussions on Fair Pricing of Medicines at the Swedish Health Economics Days

In May, the Swedish Health Economics Association (SHEA) held its annual conference, offering valuable insights into key topics in health economics, including statistical modelling, health technology assessment (HTA), reimbursement decisions, and ongoing research.

A recurring topic of discussion is the role of the Swedish Dental and Pharmaceutical Benefits Agency (TLV). This year, a particularly engaging discussion focused on how disease severity assessments impact TLV’s willingness to pay for new treatments. Medaffcon’s Scientific Advisor Johan Rehnberg attended the event.

According to Rehnberg, the presentations also addressed whether TLV’s new pricing model for orphan drugs could impact the availability of new orphan medicines.

Rehnberg noted that one presentation also explored whether TLV’s willingness-to-pay thresholds are so-called “soft” thresholds, which can occasionally be exceeded, or “hard” thresholds, which are not crossed.

“Preliminary analyses of TLV’s decisions suggest that these are hard thresholds, even if they are not officially labelled as such,” Rehnberg explained.

Rehnberg was particularly interested in an analysis that showed that these unofficial thresholds not only exist but are in practice hard limits that are not exceeded.

“This information is useful when discussing the Swedish market access landscape with pharmaceutical companies. TLV does not publicly communicate its thresholds, and everyone may not be familiar with TLV’s unofficial thresholds,” Rehnberg said.

Topics related to TLV were of special interest to Rehnberg, as he has previously worked at TLV, assessing disease severity and participating in internal evaluation processes.

Perspectives on how Pricing is Determined

Christopher McCabe, Professor of Health Economics at Queen’s University in Belfast, spoke about the fair pricing of medicines, presenting various perspectives on how pricing is determined and what society should be willing to pay pharmaceutical companies for their products.

“For example, he raised the question of whether it is fair that the European market should cover the research and development costs of products that were primarily developed for the US market, and for which companies may have already recovered a significant portion of their R&D expenses,” Rehnberg said.

Lina Koppel, postdoctoral researcher at the Meta Research Innovation Center at Stanford University, gave a presentation on meta science and the replication crisis, discussing its implications for scientific research.

“In her presentation, an interesting point emerged about how surprisingly few studies can be replicated with similar results, a phenomenon observed across most research fields,” Rehnberg noted.

“However, this picture is complicated by the fact that it may not be realistic to expect results to replicate across different populations or at different times. Perhaps the original finding was valid in its initial context but no longer holds in a new tested environment. Is that then a failure to replicate? Or does it simply reflect how the world truly works?”