THE DUTCH STEPWISE WILLINGNESS-TO-PAY THRESHOLDS: INCREASING CHALLENGES FOR ACCESS TO NEXT-GENERATION DRUG INNOVATIONS
Author(s)
Stefan Vegter, PharmD, PhD1, Kirsten Gertsen, MSc1, Siobhan Conroy, MSc, PhD1, Ronald Moers, MSc1, Maarten Postma, PhD2.
1Novartis Pharma B.V., Amsterdam, Netherlands, 2University of Groningen, Groningen, Netherlands.
1Novartis Pharma B.V., Amsterdam, Netherlands, 2University of Groningen, Groningen, Netherlands.
OBJECTIVES: To evaluate the impact of the Dutch stepwise willingness-to-pay (WTP) thresholds on the acceptability of sequential drug innovations.
METHODS: A cost-effectiveness model was developed for treatment of a hypothetical severe disease. Payer acceptability was based on the Dutch stepwise WTP thresholds, which increase with disease burden (€20,000, €50,000, and €80,000 per QALY gained). In Dutch HTA’s, disease burden is calculated with proportional shortfall, based on the nature of the disease and the current SoC. Best supportive care (BSC) was modelled to result in 4 remaining QALYs, versus 20 QALYs in perfect health. As such, a new therapy would qualify for the highest WTP. Five sequential therapies (A-E) were modelled with increasing health gains and costs, up to a curative therapy restoring perfect health. Cost-effectiveness outcomes (incremental cost-effectiveness ratios and net monetary benefit) were assessed versus each therapy’s predecessor.
RESULTS: When assessed versus BSC, all therapies were cost-effective, with net monetary benefit increasing with greater effectiveness (~€50,000 per patient for therapy A to ~€380,000 for therapy E). However, when evaluated against an improving SoC, only early therapies (A and B) were cost-effective, while later therapies (C and D) did not meet Dutch WTP thresholds. This was driven by earlier treatments replacing the SoC, thereby reducing the disease burden. As the disease burden reduced over time, a curative therapy (E) effectively faced a WTP of zero, despite delivering substantial health benefits.
CONCLUSIONS: This conceptual analysis demonstrates that the Dutch stepwise WTP thresholds creates increasing access challenges within the same disease area as SoC improves over time: later, more effective or even curative innovations may fail payer assessments despite economically justified drug prices. Policy options highlighted to alleviate this issue include designing WTP thresholds that are less dependent on residual disease burden after earlier treatments and/or explicit innovation stimuli.
METHODS: A cost-effectiveness model was developed for treatment of a hypothetical severe disease. Payer acceptability was based on the Dutch stepwise WTP thresholds, which increase with disease burden (€20,000, €50,000, and €80,000 per QALY gained). In Dutch HTA’s, disease burden is calculated with proportional shortfall, based on the nature of the disease and the current SoC. Best supportive care (BSC) was modelled to result in 4 remaining QALYs, versus 20 QALYs in perfect health. As such, a new therapy would qualify for the highest WTP. Five sequential therapies (A-E) were modelled with increasing health gains and costs, up to a curative therapy restoring perfect health. Cost-effectiveness outcomes (incremental cost-effectiveness ratios and net monetary benefit) were assessed versus each therapy’s predecessor.
RESULTS: When assessed versus BSC, all therapies were cost-effective, with net monetary benefit increasing with greater effectiveness (~€50,000 per patient for therapy A to ~€380,000 for therapy E). However, when evaluated against an improving SoC, only early therapies (A and B) were cost-effective, while later therapies (C and D) did not meet Dutch WTP thresholds. This was driven by earlier treatments replacing the SoC, thereby reducing the disease burden. As the disease burden reduced over time, a curative therapy (E) effectively faced a WTP of zero, despite delivering substantial health benefits.
CONCLUSIONS: This conceptual analysis demonstrates that the Dutch stepwise WTP thresholds creates increasing access challenges within the same disease area as SoC improves over time: later, more effective or even curative innovations may fail payer assessments despite economically justified drug prices. Policy options highlighted to alleviate this issue include designing WTP thresholds that are less dependent on residual disease burden after earlier treatments and/or explicit innovation stimuli.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA76
Topic
Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research
Topic Subcategory
Decision & Deliberative Processes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas