Potential future projects

Based on the work that we are currently doing, we have identified a few potential research topics we are considering. If you have any feedback, please let us know:

Impact of cost-responsibility for drugs in primary care.

The regions in Sweden have different policies regarding the responsibility for the cost of the drugs. In some regions, like Stockholm, the cost is covered by the region whereas in other regions the cost for the drugs is the responsibility of the primary care clinic, who then also get the corresponding compensation based on expected drug usage. In some regions, there are also some scenarios where a specific drug may be covered by the region when the drug is rather expensive, and it is expected to provide a saving in other health care. In other regions the same situation will make the primary care unit responsible to evaluate if they should prescribe the drug (increased cost) and then reduce other cost (personnel?). This would appear as a factor that may have strong impact on subscription patterns. We have a couple of specific project ideas under consideration:

  • What is the impact on anti-coagulant management in terms of drugs and self-monitoring.
    The new oral anti-coagulant drugs have proven cost effective but are still rather expensive. In some regions they have been given specific regional payment to avoid the negative financial incentive for the primary care. The self-monitoring device coagucheck proved to be cost-neutral in the evaluation by TLV.
    The aim of the study would be to analyze the impact of the cost responsibility for the drug and medical aids in the 21 regions in comparison to the standard of care. This is a prior study related to the topic based on the region of Stockholm.

Komen, Joris, Tomas Forslund, Paul Hjemdahl, Morten Andersen, and Björn Wettermark. “Effects of Policy Interventions on the Introduction of Novel Oral Anticoagulants in Stockholm: An Interrupted Time Series Analysis.” British Journal of Clinical Pharmacology 83, no. 3 (2017): 642–52. https://doi.org/10.1111/bcp.13150.

  • What is the impact in the uptake of new more expensive drugs relative the cost-policy

The aim with this study would be to select a number of drugs that are expensive and where there is a clear comparator drug who were approved by TLV during a timeframe of 3 years and compare the uptake of these drugs and the impact of the cost responsibility of the drugs. This would for example include some of the new diabets drugs. 

Please give us feedback if you see other relevant projects regarding primary care in Sweden or have feedback / interest in the above projects.