TRENDS IN PARP INHIBITOR UTILISATION BEFORE AND AFTER REASSESSMENT IN THE NETHERLANDS
Author(s)
Josephien A.J. Bakker, MSc1, Simone Koole, PhD2, Sahar Waalwijk van Doorn-Khosrovani, PharmD, PhD3, Wim Goettsch, MSc, PhD4, Christine Leopold, PhD1.
1Utrecht University, Utrecht, Netherlands, 2Zilveren Kruis, Leiden, Netherlands, 3CZ/LUMC, Tilburg, Netherlands, 4Zorginstituut Nederland, Diemen, Netherlands.
1Utrecht University, Utrecht, Netherlands, 2Zilveren Kruis, Leiden, Netherlands, 3CZ/LUMC, Tilburg, Netherlands, 4Zorginstituut Nederland, Diemen, Netherlands.
OBJECTIVES: To analyse the impact of early reimbursement of PARP inhibitors (PARPi) in the Netherlands, focusing on decision-making processes, utilisation trends, and associated expenditure.
METHODS: This descriptive policy study examined PARPi utilisation in the Netherlands between 2020 and 2025 across three components. First, key decision points per indication were mapped using publicly available regulatory, health technology assessment (HTA), and professional society sources, comprising evidence milestones, regulatory decisions, reimbursement recommendations and clinical expert guidance. Second, annual expenditure was collected for all PARPi indications using insurance claims data (Vektis, extracted in June 2026) and stratified according to the Dutch value framework. Third, utilisation trends and associated expenditure were examined before and after key policy decisions.
RESULTS: Eight out of nine indications underwent reassessment: two by payers and six by the HTA body. No clinical added benefit was found for five indications, while two showed added benefit only in the BRCA subgroup. Between 2020 and 2025, €157M were spent on PARPi indications (mainly on olaparib and niraparib), of which 56% (€88M) was attributable to indications without demonstrated OS benefit. By tumour type, 58% of PARPi expenditure on ovarian cancer and all expenditure on breast and pancreatic cancer were spent on treatments lacking demonstrated OS advantage. Niraparib prescriptions for first-line ovarian cancer declined by 82% from October 2023 to June 2025 following a recommendation by the Dutch Committee for the Evaluation of Oncological Agents (CieBOM) to restrict use to HRD-positive tumours.
CONCLUSIONS: Early reimbursement based on immature evidence resulted in substantial expenditure on treatments for which added benefit could not be confirmed upon reassessment. The decline in niraparib use after the CieBOM recommendation highlights how expert guidance can rapidly affect utilisation prior to a formal HTA reassessment. Our findings underscore the need for structured reassessment frameworks that incorporate new evidence to limit waste of healthcare resources.
METHODS: This descriptive policy study examined PARPi utilisation in the Netherlands between 2020 and 2025 across three components. First, key decision points per indication were mapped using publicly available regulatory, health technology assessment (HTA), and professional society sources, comprising evidence milestones, regulatory decisions, reimbursement recommendations and clinical expert guidance. Second, annual expenditure was collected for all PARPi indications using insurance claims data (Vektis, extracted in June 2026) and stratified according to the Dutch value framework. Third, utilisation trends and associated expenditure were examined before and after key policy decisions.
RESULTS: Eight out of nine indications underwent reassessment: two by payers and six by the HTA body. No clinical added benefit was found for five indications, while two showed added benefit only in the BRCA subgroup. Between 2020 and 2025, €157M were spent on PARPi indications (mainly on olaparib and niraparib), of which 56% (€88M) was attributable to indications without demonstrated OS benefit. By tumour type, 58% of PARPi expenditure on ovarian cancer and all expenditure on breast and pancreatic cancer were spent on treatments lacking demonstrated OS advantage. Niraparib prescriptions for first-line ovarian cancer declined by 82% from October 2023 to June 2025 following a recommendation by the Dutch Committee for the Evaluation of Oncological Agents (CieBOM) to restrict use to HRD-positive tumours.
CONCLUSIONS: Early reimbursement based on immature evidence resulted in substantial expenditure on treatments for which added benefit could not be confirmed upon reassessment. The decline in niraparib use after the CieBOM recommendation highlights how expert guidance can rapidly affect utilisation prior to a formal HTA reassessment. Our findings underscore the need for structured reassessment frameworks that incorporate new evidence to limit waste of healthcare resources.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HTA346
Topic
Health Policy & Regulatory, Health Technology Assessment
Topic Subcategory
Decision & Deliberative Processes
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, Oncology