VARYING WILLINGNESS-TO-PAY BASED ON DISEASE BURDEN- IMPACT ON HEALTH TECHNOLOGY ASSESSMENT OUTCOMES OF SPECIALIST DRUGS IN THE NETHERLANDS
Schurer M1, Vossen CY2, van Keep M2, Horscroft J3, Moorhouse JA3, Chapman AM3, Akehurst RL3
1BresMed Netherlands BV, Utrecht, UT, Netherlands, 2BresMed Netherlands BV, Utrecht, Netherlands, 3BresMed Health Solutions, Sheffield, UK
OBJECTIVES: Since June 2015, Zorginstituut Nederland (ZIN) has linked “reference values” to different levels of disease burden, using the proportional shortfall method. Using this method, disease burden ranges of 0.10-0.40, 0.41-0.70 and 0.71-1.00 are associated with willingness-to-pay thresholds of €20,000, €50,000 and €80,000 per QALY gained, respectively. In May 2018, ZIN announced that calculations of disease burden would be more transparently presented. We aimed to assess whether these changes have affected ZIN health technology assessment (HTA) outcomes for specialist drugs. METHODS: We considered recommendations for specialist drugs that were published by ZIN between 1 January 2013 and 6 March 2019 and that included a pharmacoeconomic report. RESULTS: Twenty-one ZIN evaluations were identified. Of the 10 submissions published before June 2015, five received a positive recommendation, of which two reported disease burden (both below 0.71). The remaining five evaluations did not report the disease burden and received a recommendation for conditional reimbursement (n=3) or negative recommendation (n=2). All 11 submissions after June 2015 reported a disease burden above 0.7 and ten initially received a negative recommendation, requiring further price negotiations. Eight of these were positively recommended after successful price negotiations. Since May 2018, all three evaluations included a transparent proportional shortfall calculation, compared to half of the evaluations between June 2015 and May 2018. CONCLUSIONS: ZIN HTA outcomes have changed since 2015. While pre-2015 outcomes were varied, post-2015 products often received initial negative recommendations. Since 2015, all products have fallen within the highest category of disease burden and there has been an increase in price negotiations. This may be reflective of other national policies, a shift in industry strategies, or products which address lower disease burdens following different reimbursement routes.
Conference/Value in Health Info
2019-11, ISPOR Europe 2019, Copenhagen, Denmark
Health Technology Assessment
Decision & Deliberative Processes