Presentation (CTI)

OBJECTIVES: Dutch pharmacoeconomic guidelines require a societal perspective for economic evaluations used in pharmaceutical reimbursement decision-making. This study investigated how productivity losses and informal care use are estimated in Dutch pharmaceutical reimbursement dossiers, assessed the quality and applicability of the sources and evaluated their impact on cost-effectiveness outcomes.
METHODS: Pharmaceutical reimbursement dossiers assessed by the Dutch National Health Care Institute between 2020 and 2025 were reviewed. Data was extracted on the inclusion of productivity loss and informal care use, sources used for their estimation and the quality and applicability of these sources to the dossier population and health states. The impact of societal costs was assessed by comparing incremental cost-effectiveness ratios (ICER) with and without productivity or informal care costs.
RESULTS: 63 Reimbursement dossiers were included. Productivity losses were incorporated in 68% of dossiers, while informal care use was in 95%. The main sources were clinical expert input and published studies, but both showed important limitations. Clinical expert input quality was assessed based on criteria covering prior literature search, expert number and identifiability, structured elicitation, type of elicited data and availability of meeting minutes. No dossier using expert input met all quality criteria. Published studies were often not directly applicable, as 65% of studies measuring productivity losses and 72% of studies measuring informal care use did not match both the population and health states in the reimbursement dossier. Productivity and informal care costs had limited impact on cost-effectiveness outcomes, with median ICERs changes of 0.15% and 0.21%, respectively. However, substantial differences in these costs between the intervention and the comparator were observed in a subset of dossiers.
CONCLUSIONS: Sources used to estimate productivity losses and informal care use in Dutch reimbursement dossiers were often limited in quality. Although these costs usually had little influence on cost-effectiveness outcomes, substantial effects occurred in a few dossiers.