THE COST-EFFECTIVENESS GAP: PHYSICIANS' PERCEPTIONS, KNOWLEDGE, AND WHERE TO GO FROM HERE
Author(s)
Evelien Yap, PharmD1, Bart Van Der Lelie, MSc1, JMC Verheggen, MSc2, RV Van Miltenburg, MSc2.
1LYSIAC, Zeist, Netherlands, 2Samhealth, Baarn, Netherlands.
1LYSIAC, Zeist, Netherlands, 2Samhealth, Baarn, Netherlands.
OBJECTIVES: Clinical specialists' insights inform health technology assessment (HTA) and reimbursement decisions, including cost-effectiveness (CE) evaluations. This study explores how specialist physicians across six disciplines perceive CE, its role in reimbursement, and its relevance in clinical practice.
METHODS: An online, multiple-choice survey on HTA knowledge and opinion was conducted in the Netherlands (Q4 2025-Q2 2026). 260 physicians participated across six specialist groups for which access to expensive medicines is a recurring issue: cardiologists (n=105), vascular internists (n=24), dermatologists (n=45), nephrologists (n=35), lung-oncologists (n=25) and MS-neurologists (n=26). Participants were drawn from the Samhealth medical panel. Results are reported as proportions with 95% Wilson confidence intervals (CI). This analysis is part of the AccessWijzer research program.
RESULTS: Cost-effectiveness was widely seen as central to medicine reimbursement, both in principle and in practice. 51% of physicians perceived CE as the most important reimbursement criterion (95%CI 44-56), versus 32% for effectiveness (95%CI 28-39), although effectiveness is formally the primary condition for inclusion; 90% reported that CE is relevant to discussions about medicine availability within their hospital. Variations across specialties were present, but not statistically significant, with the largest contrast between oncology and dermatology. Yet more than two-thirds of physicians misunderstood CE, for example regarding which costs enter the ICER calculation and how the ratio should be interpreted. This misperception was mostly consistent across specialties.
CONCLUSIONS: Specialist physicians consistently perceive cost-effectiveness as a factor in daily practice and as the dominant reimbursement criterion, whereas effectiveness is the formal prerequisite. This is understandable given that effective but non-cost-effective medicines have recently been denied reimbursement in the Netherlands. Despite its perceived importance, understanding of CE remains limited across specialties. These findings raise follow-up questions about the significance of the CE perception gap: is this a problem, and if so, for whom and how? We are investigating what step logically follows.
METHODS: An online, multiple-choice survey on HTA knowledge and opinion was conducted in the Netherlands (Q4 2025-Q2 2026). 260 physicians participated across six specialist groups for which access to expensive medicines is a recurring issue: cardiologists (n=105), vascular internists (n=24), dermatologists (n=45), nephrologists (n=35), lung-oncologists (n=25) and MS-neurologists (n=26). Participants were drawn from the Samhealth medical panel. Results are reported as proportions with 95% Wilson confidence intervals (CI). This analysis is part of the AccessWijzer research program.
RESULTS: Cost-effectiveness was widely seen as central to medicine reimbursement, both in principle and in practice. 51% of physicians perceived CE as the most important reimbursement criterion (95%CI 44-56), versus 32% for effectiveness (95%CI 28-39), although effectiveness is formally the primary condition for inclusion; 90% reported that CE is relevant to discussions about medicine availability within their hospital. Variations across specialties were present, but not statistically significant, with the largest contrast between oncology and dermatology. Yet more than two-thirds of physicians misunderstood CE, for example regarding which costs enter the ICER calculation and how the ratio should be interpreted. This misperception was mostly consistent across specialties.
CONCLUSIONS: Specialist physicians consistently perceive cost-effectiveness as a factor in daily practice and as the dominant reimbursement criterion, whereas effectiveness is the formal prerequisite. This is understandable given that effective but non-cost-effective medicines have recently been denied reimbursement in the Netherlands. Despite its perceived importance, understanding of CE remains limited across specialties. These findings raise follow-up questions about the significance of the CE perception gap: is this a problem, and if so, for whom and how? We are investigating what step logically follows.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR34
Topic
Economic Evaluation, Health Policy & Regulatory
Disease
No Additional Disease & Conditions/Specialized Treatment Areas