A comparative study of reimbursement application patterns between Iceland and Sweden

Objective  The objective of this paper was to examine access to new reimbursed prescription drugs in two European countries, Sweden and Iceland, both of which are small in terms of economic importance. We performed the analysis through a comparison of the number of accepted and rejected reimbursement applications. We also investigated the price level of reimbursed drugs in the two countries. Methods  We performed a retrospective, comparative study of actual reimbursement decisions in Iceland and Sweden. For all reimbursement decisions in 2009 we investigated and compared the date of decision, the type of decision and, for accepted applications, prices. Key findings  Iceland made 18 reimbursement decisions, Sweden made 30. In addition, Sweden received 11 applications that were withdrawn at a late stage in the application process. Two applications were rejected in Iceland; nine applications were rejected in Sweden. Out of the 16 drugs reimbursed in Iceland, there was no decision in Sweden for one of the drugs by June 2010; all others were reimbursed. Out of the 20 drugs reimbursed in Sweden, there was no decision in Iceland for 11 of the drugs by June 2010. There was no decision in Iceland for most of the drugs that were rejected for reimbursement in Sweden. The median price was 5% higher in Iceland than in Sweden. Conclusions  For the year 2009, Sweden received far more applications than Iceland, and also made decisions on more applications. However, the number of reimbursed new medicines was only slightly higher in Sweden. Most of the medicines reimbursed in Iceland in 2009 already existed in Sweden or, if not, were accepted in 2009. The prices of reimbursed medicines were higher in Iceland than in Sweden. Although further evidence is needed, this paper indicates that pharmaceutical companies apply for reimbursement of prescription drugs in Sweden before applying in Iceland.