OBJECTIVES: Since 2002, the BRP for medicinal products claiming ATV requires the evaluation of the therapeutic and pharmaco-economic value as compared to alternatives. The study aim was to analyze the effect of ATV and ICER on the DRD. METHODS: The RIZIV administrative database was used for extracting all files claiming ATV submitted between January 2002 and February 2008. ICERs expressed per QALY or per LYG were pooled. ATV was a binary outcome variable (ATV either present or absent). The DRD was either positive or negative. Statistical analysis (logistic regression /backwards elimination) was performed using SAS EG. The significance level was set at 0.05. Only complete cases were analyzed. RESULTS: A total of 138 submissions fulfilled the criteria. Data were available for all variables in only 76 (55,1%) cases. ATV and ICER were both significantly (p<0.01) related with the final DRD. The odds of a positive DRD increase to 9.5-fold if ATV was granted and decrease to 0.45-fold if the ICER increases €10,000. No significant interactions were observed (p > 0.10). CONCLUSIONS: Based on this sample, our analysis indicates that both ATV and ICER have a prognostic (but opposite) effect on the final DRD in Belgium. Further investigation should consider the potential effects of other variables such as budget impact, disease category, price and others on the DRD.