Abstract
Assessment of value for money of new drugs is an important part in decision-making about the price and use of new drugs. The high prices of many new drugs also means that inappropriate use for patients who gain little or no benefit from the treatment creates a high "opportunity cost" in terms of health losses for other patients, for whom the resources could be better used. Sales of cancer drugs in Sweden have risen sharply over the past decade, but the growth of sales has slowed in recent years. There are significant variations among different health regions in the use of cancer drugs, and these variations have increased over the past 5 years. We discuss the issues involved in applying the principle of cost-effectiveness with examples from breast cancer and leukaemia. The debate surrounding the introduction of cancer drugs is focused on the question of who should be the leader in the introduction process. Our view is that in Sweden, with a regionalised health-care system, decisions must be made where patient and financial responsibility rests, on the county councils. However, there is a need for leadership at the national level for assessment and follow-up. Internationally, secret (undisclosed) rebates, based on what is often a very high list price for the drug, are common. There is no tradition of this in Sweden, and there is resistance to this type of discounting since price control in Sweden should be based on public prices. However, the county councils' responsibility for the introduction of new cancer drugs allows local agreements to be made, in which price is included as one component, improving access for patients without reducing incentives for innovation. © 2014 The Authors.