OBJECTIVES: To analyse reimbursement trends by evaluating Health Technology Assessment (HTA) submissions and appraisals made for non-small-cell lung cancer (NSCLC) over the last decade between the United Kingdom (UK) and the Netherlands.

METHODS: A search was conducted in the databases from UK (NICE) and the Netherlands (Dutch Health Care Institute (ZIN)) between January 2008 and December 2018 for NSCLC treatments. Exclusion criteria concerned: ‘treatments for small cell lung cancer’ and ‘treatments available before 2008 or HTA submissions after 2018’. HTA decisions were evaluated by drug class, indication, decision, economic- and budget impact outcomes.

RESULTS: 29 HTA submissions were appraised for 15 unique NSCLC treatments between 2008-2018. In the UK 76.9% of all HTA appraisals received a positive recommendation for reimbursement, of which 61.5% were conditional on a patient access agreement (PAS). In the Netherlands 25% initially received a negative recommendation for reimbursement by ZIN, however after negotiations with the Dutch government 93.7% of all submissions received reimbursement. The average duration for full HTA appraisals until final decision was significantly shorter for the Netherlands in comparison to the UK: 198 versus 313 days.

During this 10 years period the budget impact regulations changed as in 2015 the Netherlands implemented an annual budget impact cap of €2.5 million per year, and the UK implemented in 2017 a cap of £20 million in any of the first 3 years. When exceeded, negotiations for PAS agreements are mandatory for reimbursement in the UK regardless of the incremental cost-effectiveness ratio (ICER), while in the Netherlands the lock procedure for expensive medicines will be started. Both procedures can lead to a longer appraisal process.

CONCLUSIONS: Both countries show an increasing challenging reimbursement environment for NSCLC treatments. The amount of positive recommendations for reimbursement were similar in both countries, whereas the Netherlands showed a higher reimbursement rate after negotiations.