title: Health economic evaluations in reimbursement decision making in the Netherlands: time to take it seriously?
abstract: Health technology assessment already informed Dutch policymaking in the early 1980s. Evidence of health economic evaluations is, however, only systematically used in drug reimbursement decision making. Outpatient drugs with an added therapeutic value and expensive specialist drugs require evidence from an economic evaluation. Due to many exemptions, however, the availability of evidence of health economic evaluations remains rather low. Although the Dutch reimbursement agency suggested a cost-effectiveness threshold range depending on the severity of the disease (i.e., €10,000 - 80,000 per Quality Adjusted Life Year), it was never confirmed nor endorsed by the Ministry of Health. It is highly questionable whether health economic evaluations currently play a role in actual Dutch reimbursement decision making. Although the requirements exist in policy procedures, recent cases show that Dutch policymakers experience great difficulties in putting restrictions on reimbursement based on evidence from health economic evaluations. The near future will show whether the need will increase to base decisions on societal value for money, and whether Dutch policymakers show the courage to take health economic evaluations seriously.
authors.affiliation: Institute of Health Policy and Management (iBMG), Erasmus University, Rotterdam, The Netherlands. Electronic address: franken@bmg.eur.nl.
authors.forename: Margreet
authors.initials: M
authors.lastname: Franken
authors.affiliation: Institute of Health Policy and Management (iBMG), Erasmus University, Rotterdam, The Netherlands.
authors.forename: Marc
authors.initials: M
authors.lastname: Koopmanschap
authors.affiliation: Institute of Health Policy and Management (iBMG), Erasmus University, Rotterdam, The Netherlands.
authors.forename: Adri
authors.initials: A
authors.lastname: Steenhoek
mesh_terms: D003362:Cost-Benefit Analysis / Q000191:economics* / Q000639:trends; D003431:Cross-Cultural Comparison; D003659:Decision Making, Organizational; D016527:Drug Costs / Q000639:trends; D005544:Forecasting; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000191:economics / Q000639:trends; D009313:National Health Programs / Q000191:economics* / Q000639:trends; D009426:Netherlands; D019057:Quality-Adjusted Life Years; D012051:Reimbursement Mechanisms / Q000191:economics* / Q000639:trends
keywords: Gesundheits-ökonomische Evaluierung; Gesundheitspolitik; Health Technology Assessment (HTA); Health economic evaluation; Krankenkassenleistungen; Niederlande; The Netherlands; health technology assessment; pharmaceutical market; pharmazeutische Industrie; policy making; reimbursement