What Tips the Scale Toward Reimbursement? A Dutch-led Comparison of Pharmacoeconomic Evaluations Across the Netherlands, Sweden, and the United Kingdom
Author(s)
Emma Palsma, MSc, Leonie van Bemmelen, MSc, Carin Uyl-De Groot, PhD, Caroline van der Meijden, PhD.
iMTA/ESHPM, Erasmus University, Rotterdam, Netherlands.
iMTA/ESHPM, Erasmus University, Rotterdam, Netherlands.
OBJECTIVES: This study aimed to identify common pitfalls in pharmacoeconomic evaluations submitted as part of new drug applications in the Netherlands, and to compare their frequency and impact with similar evaluations in the UK and Sweden. Particular attention was paid to how these pitfalls in evaluations influence final reimbursement recommendations in the Netherlands, United Kingdom and Sweden.
METHODS: We reviewed national pharmacoeconomic evaluations of drugs assessed in the Netherlands between January 1, 2023 and June 25, 2025. Dutch reimbursement dossiers and accompanying minutes from the WAR (Scientific Advisory Board, ZIN) were analyzed and categorized into themes and corresponding subthemes. Comparative evaluations from the UK (NICE) and Sweden (TLV) were included to triangulate findings. For these cases, final reimbursement recommendations were verified to explore the impact of pharmacoeconomic modeling on decisions.
RESULTS: In the Netherlands, approximately 60 pharmacoeconomic evaluations were reviewed. Of these, about two-thirds had corresponding evaluations in the UK (NICE) and one-sixth in Sweden (TLV), covering identical drugs and indications.
Thematic analysis revealed that the most frequently cited critique in both the Netherlands and Sweden was excessive uncertainty and inadequate sensitivity analyses. In contrast, the UK’s NICE most often highlighted methodological shortcomings in modelling. Other common concerns included limitations in applicability and implementation, as well as issues with indirect comparisons.
Discrepancies in final reimbursement recommendations were observed in approximately half of the Dutch cases when compared with those from the UK or Sweden.
CONCLUSIONS: Despite divergences in reimbursement decisions, the underlying themes of critique by ZIN, NICE, and TLV were largely consistent, reflecting shared concerns about the robustness and transparency of submitted evidence.
Reimbursement dossiers should emphasize sensitivity analysis, methodological rigour in modelling, and practical applicability. In particular, the validity of indirect comparisons warrants special attention, as it is increasingly common for trial comparators to differ from the national standard of care.
METHODS: We reviewed national pharmacoeconomic evaluations of drugs assessed in the Netherlands between January 1, 2023 and June 25, 2025. Dutch reimbursement dossiers and accompanying minutes from the WAR (Scientific Advisory Board, ZIN) were analyzed and categorized into themes and corresponding subthemes. Comparative evaluations from the UK (NICE) and Sweden (TLV) were included to triangulate findings. For these cases, final reimbursement recommendations were verified to explore the impact of pharmacoeconomic modeling on decisions.
RESULTS: In the Netherlands, approximately 60 pharmacoeconomic evaluations were reviewed. Of these, about two-thirds had corresponding evaluations in the UK (NICE) and one-sixth in Sweden (TLV), covering identical drugs and indications.
Thematic analysis revealed that the most frequently cited critique in both the Netherlands and Sweden was excessive uncertainty and inadequate sensitivity analyses. In contrast, the UK’s NICE most often highlighted methodological shortcomings in modelling. Other common concerns included limitations in applicability and implementation, as well as issues with indirect comparisons.
Discrepancies in final reimbursement recommendations were observed in approximately half of the Dutch cases when compared with those from the UK or Sweden.
CONCLUSIONS: Despite divergences in reimbursement decisions, the underlying themes of critique by ZIN, NICE, and TLV were largely consistent, reflecting shared concerns about the robustness and transparency of submitted evidence.
Reimbursement dossiers should emphasize sensitivity analysis, methodological rigour in modelling, and practical applicability. In particular, the validity of indirect comparisons warrants special attention, as it is increasingly common for trial comparators to differ from the national standard of care.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE754
Topic
Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research
Topic Subcategory
Trial-Based Economic Evaluation
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Gastrointestinal Disorders, Oncology, Rare & Orphan Diseases, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)