OBJECTIVES: Drugs that increase life expectancy may cause additional healthcare consumption in the life years gained. This healthcare consumption may be partly related to the disease, but there is also healthcare consumption that is not directly related to the disease. This study assessed the impact of including the future medical costs on the incremental cost-effectiveness ratios (ICER) of pharmacoeconomic assessments of the National Health Care Institute (Zorginstituut Nederland; ZIN).

METHODS: In this exploratory study, the ICERs of pharmacoeconomic assessment reports published between 2016 and May 2019 were collected. Pharmacoeconomic assessment reports in which both ICERs with and without future medical costs were reported were considered for analysis. ZIN publishes pharmacoeconomic reports when there is a therapeutic added value in comparison with the alternative treatment (based on advice of the Scientific Advisory Board) and when the total expected budget impact will exceed €10 million per year after reimbursement.

RESULTS: ICERs with and without future medical costs were reported in 32% of all pharmacoeconomic assessment reports since 2016, the year in which inclusion of these costs became recommended. This study included ICERs of 1 extramural (cardiovascular) and 6 intramural drugs (oncology). All ICERs increased with a median of 27% (min 3%, max 169%) after including future medical costs. On average, the ICERs increased with €8,600 per QALY. ICERs that were lower than the relevant willingness-to-pay threshold (71%) did not exceed the threshold when future medical costs were included. The methodology of including future medical costs was insufficiently described in the submitted reimbursement dossiers, which hampered comparison.

CONCLUSIONS: Although the inclusion of future medical costs had a variable impact on the ICERs, the relevant willingness-to-pay thresholds were not exceeded. It is therefore unlikely that the inclusion of these costs in the base case analysis would have influenced former reimbursement recommendations of ZIN.