In relation to the Swedish ethical platform for priority setting in health-care it is debated what role cost-effectiveness should play. In the article an ethical analysis is presented showing that a limited role risks leading to unequal priorities between similar needs in conflict with the human dignity and need-solidarity principles of the platform. It is also argued that resulting problems with effect comparability over different conditions and resulting equality problems with the current praxis can be mitigated through strategies like explicitly considering outcome measure and by adjusting the cost-effectiveness threshold under specific conditions.