10 Years Of Reimbursement Decisions In The Netherlands: An Overview

Abstract

Objectives: Pharmaceutical reimbursement in Ireland is governed by agreements between the pharmaceutical representative organisation, the Irish Pharmaceutical Healthcare Association (IPHA), and the state-run Health Service Executive (HSE). The current agreement runs from 2016 to 2020 [IPHA/HSE Framework Agreement on the Supply and Pricing of Medicines]. We explored the effects of two previously completed agreements (commenced 2006 and 2012) on health technology assessment (HTA) submissions in Ireland. MethOds: A descriptive analysis was conducted, using publicly available information on HTA submissions since 2009, when the National Centre for Pharmacoeconomics (NCPE) introduced a rapid review (RR) process. A full HTA submission may be requested following RR. A total of 289 RR submissions were made during the period 2009 -2016 [2009 to 2012 (A1) and 2012 to 2016 (A2)]. Submissions were examined to identify assessment process patterns, disease areas and sponsor IPHA membership. Results: The number of RR requests available for analysis increased between agreements (A1: n= 93; A2: n= 193). The rate of requests for full HTA following RR submission increased (A1: 56%; A2: 62%). A reduction in the rate of HTAs submitted following request was observed (A1: 79%; A2: 60%). Applications where a HTA was requested, but not submitted, and ultimately lead to reimbursement occurred with increasing frequency in the A2 period compared to A1. The main disease areas submitted for RR (neoplasm, endocrine, circulation, and infections) remained similar between agreements, with a notable increase in the proportion of cancer therapies (A1: 15%; A2: 29%). There was no correlation between the rate of completed HTA submissions and IPHA membership. cOnclusiOns: The trends in assessment display a modest increase in the rate of full HTA requests. However, the rate of completion of submitted HTAs has decreased, suggesting that the negotiation route post-RR, which is now formalised in the 2016 agreement, is a viable route to reimbursement.