OBJECTIVES: Pharmaceutical technologies are placed in the basic insurance package in the Netherlands based on four criteria: Necessary care, Effectiveness, Cost-Effectiveness and Feasibility. While only effectiveness is anchored in law by assessing established medical science and medical practice, cost-effectiveness has become increasingly more important in decision making. Cost-effectiveness estimates of technologies are weighed against the Willingness To Pay (WTP) thresholds. The objective of this research is to investigate the establishment and evolution of the WTP-thresholds in the Netherlands.

METHODS: A literature search was done on publications of the Dutch HTA bodies and scientific publications on the setting of the WTP-thresholds, and the relation with disease burden.

RESULTS: In 2006, The ‘Council of public health and society’ suggested a linear model to define the WTP-threshold related to burden of disease up to 80.000 EUR/QALY. The maximum value was based on several references published between 1999-2006 (e.g. costs of one year nursing home; systematic review of the value of statistical life in the US). In 2010 the Health Care Institute (ZIN) set two additional thresholds, stepwise increasing with burden of disease (starting from a disease burden of 0.1 based on the calculation of the proportional shortfall due to disease, setting thresholds at 20.000;50.000 and 80.000 EUR/QALY for the highest burden of disease (>0.7)). Since introduction, the thresholds have not been adjusted. If corrected for inflation until today, the maximum threshold would increase to 117.000 EUR/QALY.

CONCLUSIONS: The WTP-threshold has not been changed since 2006, while having an increasingly important role in decision making, resulting in a devaluation of the WTP for innovation. In order to have innovations available in the Netherland, there is a need to evolve the WTP-threshold within the current system: considering all four criteria, emphasizing the need for periodic reassessment of the threshold in collaboration with healthcare stakeholders.