OBJECTIVES:

Since 2005, the Dutch National Health Care Institute (ZIN) has made it mandatory to include a pharmacoeconomic assessment of drugs that are submitted for reimbursement, with an informal, variable threshold for cost per quality adjusted life-year (QALY). The aim of this study is to create an overview of HTA submissions, and compare the reimbursement decisions to the informal threshold for highly innovative drugs used in the Netherlands (€80,000/QALY).

METHODS:

The database of the National Health Care Institute was addressed to obtain summaries of healthcare technology appraisals containing pharmacoeconomic sections that included an incremental cost-effectiveness ratio (ICER or cost per QALY). The following data, if available, was retrieved from the documents: ICER, drug costs, budget impact, and advice to the minister. Subsequently, all extractions were stratified by informal threshold and disease area.

RESULTS:

ZIN assessed the cost-effectiveness of 111 HTA submissions. It appeared that 21 (19%) drugs had an ICER higher than €80,000/QALY. Notably, in 14 of these assessments, it was advised to the minister to reimburse these drugs. In 2 cases, the advice was not to reimburse based on the unfavorable cost-effectiveness and/or high budget impact. In 4 cases, an official advice was postponed without reason, while in 1 case the advice was given to negotiate a lower drug price to achieve a more favorable cost-effectiveness.

CONCLUSIONS:

When focusing on reimbursement decisions for health technologies with ICERs over 80,000/QALY, it seems that ZIN allows a higher threshold than it informally communicates.