OBJECTIVES: The National Health Care Institute (ZIN) advises the minister of healthcare (MOH) if a drug should be reimbursed. Recently it was suggested to implement a threshold value for the incremental cost-effectiveness ratio (ICER) that is related to the burden of disease (BOD). The higher the BOD, the higher the threshold of cost per QALY. This research aims to explore how the introduction of a threshold for ICERs based on BOD for drugs would influence the current reimbursement of drugs using a retrospective analysis.

METHODS: All reports of economic analyses that were part of an HTA assessment published by ZIN from 1-jan-2010 to 1-jul-2016 were used and data were collected using a standardized case report form. From these publications, the appraisal outcomes, ICERs and BOD were extracted. If the BOD calculation using the proportional shortfall method was missing it was completed using the WHO-rapport “Burden of disease”. Several possible thresholds as suggested in ZIN guidelines were used as threshold values.

RESULTS: ZIN published 219 recommendations on reimbursement. 35 publications included a pharmacoeconomic analysis from which an ICER and a BOD could be obtained. Without a threshold linked to BOD 83% of all drugs were reimbursed. If a threshold linked to three BOD strata was used, i.e. €20.000 per QALY for a BOD between 0-0,4, €50.000 per QALY for a BOD between 0,4-0,7 and €80.000 per QALY for a BOD between 0,7-1, only 32% of drugs would be reimbursed.

CONCLUSIONS: Based on our data the use of a threshold based on BOD would substantially decrease the number of reimbursable drugs in the Netherlands. More research is needed on the impact of using a threshold on prices and reimbursement rates and the best form of implementation to assure overall system equity and efficiency.