Kvantifiering av sjukdomars svårighetsgrad vid prioriteringar av sjukvårdsresurser : En jämförelse av kvantitativ och kvalitativ metod

Sammanfattning: The Swedish healthcare system strives to maximize the health of the population and at the same time consider a fair distribution of health. In this consideration, the severity of disease is an important attribute as high severity signals a higher need for healthcare. Currently, the Dental and pharmaceuticals benefits agency (TLV) operationalizes this approach by striking a balance between efficiency and equity when deciding which prescription pharmaceuticals that should be reimbursed. The agency uses a qualitative approach to assess the severity of diseases. There are however quantitative methods that can be used to assess disease severity such as absolute and proportional shortfall, indicating how much health is lost compared to the general population. In this study, we quantify the severity of different diseases using absolute and proportional shortfall based on information available from TLV decisions and compare those with the agency´s qualitative assessment. To quantify severity, we use data from publicly available decision-documents from TLV and estimated health of the general population.  The results show that quantitative assessments of disease severity with absolute and proportional shortfall differ from the qualitative assessments made by TLV. A large range of absolute and proportional shortfall estimates was observed for diseases assessed to have a specific severity by TLV. A quantitative approach to disease severity could contribute to a more objective severity assessments than current practice. Furthermore, as disease severity is an important aspect of TLV´s prioritization a quantitative assessment could contribute to a fairer allocation of resources in healthcare.