BACKGROUND: Inclusion or not of a treatment strategy in the publicly financed 
health care is really a matter of prioritisation. In Sweden priority setting 
decisions are governed by law in which it is stated that decisions should be 
guided by firstly the principle of need and secondly the principle of 
cost-effectiveness.
OBJECTIVE: The purpose of the paper is to discuss and illustrate the roles of 
need and cost-effectiveness in decisions on inclusion or not of treatment 
strategies in the publicly financed health care.
METHODS: The theoretical backgrounds of need and cost-effectiveness are 
discussed in short, both with respect to their meaning and to their potential 
roles in decisions on priority setting. Four treatment strategies, Viagra, 
Rivastigmine, statins, and lung transplants, are analysed with respect to 
whether either cost-effectiveness or need, or both, seem to have played a role 
in the decisions of inclusion or not in the basic health care package.
RESULTS: Both need and cost-effectiveness are important and should be important 
aspects when making decisions on priority setting. From the examples of the four 
treatment strategies it seems that decisions are almost exclusively made with 
reference to the principle of need.
CONCLUSIONS: The most evident conclusion to be drawn from this study is that 
decisions on priority setting are almost solely based on the principle of need. 
This implies that the principle of cost-effectiveness is given very little 
space, which is a problem as this means an obvious risk of inefficient resource 
use.