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First Fundamental Decision of the Federal Supreme Court of Switzerland on Cost-Effectiveness in the Area of Human Healthcare

Published online by Cambridge University Press:  20 January 2017

Felix Kesselring
Felix Kesselring*
Affiliation:
VISCHER Ltd., Zurich, Switzerland,
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Abstract

In rendering this decision, the Federal Supreme Court of Switzerland entered for the first time into a detailed analysis of questions relating to the cost-effectiveness of human healthcare. The decision, concerned with the availability of a drug for a rare genetic disease, makes it clear that the maximum amount available from a public health insurance provider for the medical treatment in a particular case has been reached once the amount requested by the individual patient cannot also be provided to all other persons in a comparable situation. It remains unclear, however, how cost-effectiveness is to be assessed below this maximum amount (author's headnote).

Type
Case Notes
Information
European Journal of Risk Regulation , Volume 2 , Issue 3 , September 2011 , pp. 442 - 446
Copyright
Copyright © Cambridge University Press 2010

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References

1 Judgment of the Federal Supreme Court of Switzerland of 23 November 2010 (BGE 136 V 395 et sqq.; 9C_334/2010). The judgment is available in German only. It can be downloaded from the website of the Federal Supreme Court of Switzerland (<http://www.bger.ch>). The judgment deals mainly with Art. 5, para. 2 and Art. 8, para. 1 of the Federal Constitution of the Swiss Confederation (SR 101) and with Art. 24, Art. 25, paras. 1 and 2, litera b, Art. 34, para. 1 and Art. 52, para. 1, litera b of the Federal Act on Health Insurance (SR 832.10), Arts. 34 and 64 et sqq. of the Federal Ordinance on Health Insurance (SR 832.102) and Arts. 30 et sqq. of the Federal Ordinance on the Reimbursement in the Compulsory Health Insurance (SR 832.112.31).

2 Case 136 V 395 et sqq., consideration 1.

3 Case 136 V 395 et sqq., considerations 4–6.

4 Art. 24, Art. 25, paras. 1 and 2, litera b, Art. 34, para. 1 and Art. 52, section 1, litera b of the Federal Act on Health Insurance; Arts. 34 and 64 et sqq. of the Federal Ordinance on Health Insurance; Arts. 30 et sqq. of the Federal Ordinance on the Reimbursement in the Compulsory Health Insurance.

5 BGE 131 V 349 et sqq. and BGE 130 V 532 et sqq., both concerning a so-called off-label-use (i.e. the practice of prescribing drugs for an unapproved indication or in an unapproved age group or unapproved dose).

6 Art. 32, para. 1 of the Federal Act on Health Insurance and Art. 5, para. 2 of the Federal Constitution of the Swiss Confederation respectively.

7 Case 136 V 395 et sqq., consideration 7.4.

8 Case 136 V 395 et sqq., consideration 7.5.

9 Case 136 V 395 et sqq., consideration 7.5.

10 Case 136 V 395 et sqq., consideration 7.6.

11 Art. 8, para. 1 of the Federal Constitution of the Swiss Confederation.

12 For example BGE 132 I 97 et sqq. and BGE 121 I 279 et sqq.

13 Case 136 V 395 et sqq., consideration 7.7.

14 Case 136 V 395 et sqq., consideration 7.8.

15 Case 136 V 395 et sqq., consideration 7.5.

16 Case 136 V 395 et sqq., consideration 7.5.

17 Cf. considerations of the Court above section II.

18 Cf. Donatsch, Andreas, Strafrecht III, 9th ed. (Zurich 2008), pp. 3 et sqq. Google Scholar; Stratenwerth, Günter, Jenny, Guido, Bommer, Felix, Schweizerisches Strafrecht Besonderer Teil I: Straftaten gegen Individualinteressen, 7th ed. (Berne 2010), § 1 margin number 6.Google Scholar

19 Cf. similarly Tomas Poledna, Marianne Tschopp, “Der Myozyme-Entscheid des Bundesgerichts”, in Jusletter, 7 February 2011, margin number 30.

20 Cf. Felix Kesselring, “Kosten-/Nutzen-Beziehung im Bereich der menschlichen Gesundheit”, in 4 Aktuelle Juristische Praxis (2011), p. 576.

21 Cf. for instance Müller, Jörg Paul, Schefer, Markus, Grundrechte in der Schweiz, 4th ed. (Berne 2008), pp. 666 et sqq. Google Scholar including further references; Markus Schott, Patientenauswahl und Organallokation (Diss. Basel, Basel/Geneva/Munich 2001), pp. 55 et sqq.; cf. references of the Court itself in consideration 7.5.

22 Cf. for instance Markus Schott, supra note 21, pp. 193 et sqq., or Becchi, Paolo, Bondolfi, Alberto, Kostka, Ulrike, Seelmann, Kurt (eds), Organallokation Ethische und rechtliche Fragen (Basel 2004).Google Scholar

23 Art. 164, para. 1 of the Federal Constitution of the Swiss Confederation.

24 Art. 10, paras. 1 and 2 and Art. 12 of the Federal Constitution of the Swiss Confederation; Art. 2 of the Convention for the Protection of Human Rights and Fundamental Freedoms (SR 0.101).

25 Art. 106, para. 2 of the Federal Act on the Federal Supreme Court (SR 173.110).

26 Art. 35, para. 1 of the Convention for the Protection of Human Rights and Fundamental Freedoms; Villiger, Mark E., Handbuch der Europäischen Menschenrechtskonvention (EMRK), 2nd ed. (Zurich 1999)Google Scholar, margin notes 134 et sqq. with further references; Cases of the European Court of Human Rights, for instance, Carlson v. Switzerland of 6 November 2008, Case No. 49492/06, margin numbers 97 et sqq., G.B. v. Switzerland of 3 February 2000, Case No. 27426/95 (Decision as to the Admissibility of the Case), margin number 3.

27 Cf. Jörg Paul Müller, Markus Schefer, supra note 21, pp. 53 et sqq., 74 et sqq. and 763 et sqq. including further references; Rhinow, René, Schefer, Markus, Schweizerisches Verfassungsrecht, 2nd ed. (Basel 2009)Google Scholar, margin numbers 1177, 1252 et sqq. and 3447 et sqq.; Egli, Patricia, Drittwirkung von Grundrechten (Diss. Zurich, Zurich 2002), pp. 155 et sqq., 235 et sqq. and 283 et sqq. Google Scholar; Kälin, Walter, Künzli, Jörg, Universeller Menschenrechtsschutz, 2nd ed. (Basel 2008), pp. 325 et sqq. and 353 et sqq. Google Scholar; Häfelin, Ulrich, Haller, Walter, Keller, Helen, Schweizerisches Bundesstaatsrecht, 7th ed. (Zurich 2008)Google Scholar, margin numbers 368 and 918; BGE 126 II 300 et sqq., BGE 119 Ia 28 et sqq.; Cases of the European Court of Human Rights, for instance, D. v. the United Kingdom of 21 April 1997, Case No. 30240/96, N. v. the United Kingdom of 27 May 2008, Case No. 26565/05.

28 Arts. 71a and 71b of the Federal Ordinance on Health Insurance (AS 2011 654).

29 Cf. Art. 164, para. 1 of the Federal Constitution of the Swiss Confederation.