Health economic evaluations in reimbursement decision making in the Netherlands: Time to take it seriously?

Franken, M; Koopmanschap, Marc; Steenhoek, Adri

doi:10.1016/j.zefq.2014.06.016

Cited by 18 publications

(23 citation statements)

References 9 publications

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“…The lack of delistings seems to indicate that cost-effectiveness had at best a very modest impact on the reimbursement decisions of orphan drugs [15]. Discussions around the 3 reassessed drugs led to fierce public and political debate, as was already mentioned in section 2.…”

Section: Outcomes Of Conditional Reimbursementmentioning

confidence: 98%

Governance of conditional reimbursement practices in the Netherlands

2015

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When entering the market, orphan drugs are associated with substantial prices and a high degree of uncertainty regarding safety and effectiveness. This makes decision making about the reimbursement of these drugs a complex exercise. To advance on this, the Dutch government introduced a conditional reimbursement trajectory that requires a re-evaluation after four years. This article focuses on the origins, governance and outcomes of such a conditional reimbursement trajectory for orphan drugs. We find that the conditional reimbursement scheme is the result of years of discussion and returning public pressure about unequal access to expensive drugs. During the implementation of the scheme the actors involved went through a learning process about the regulation. Our analysis shows that previous collaborations or already existing organisational structures led to faster production of the required data on cost-effectiveness. However, cost-effectiveness evidence resulting from additional research seems to weigh less than political, judicial and ethical considerations in decision making on reimbursement of orphan drugs in the Netherlands.

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Section: Outcomes Of Conditional Reimbursementmentioning

confidence: 98%

Governance of conditional reimbursement practices in the Netherlands

2015

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“…Efficiency considerations often fall by the wayside and are trumped by evidence of clinical benefit, political and/or other considerations (Martin et al, ; Eddama and Coast, ; Boon et al, ; Armstrong et al, ). There is no agreement on what these decision criteria should be, how important they should be relatively to one another, nor is there a common framework for how they should be used in combination (Chabot and Rocci, ; Boon et al, ; Franken et al, ; McDonald et al, ; Franken et al, ; Cleemput et al, ; Drummond, ; Franken et al, ). There is also a lack of guidance to the interpretation of evidence, including PE (Wranik, ; Franken et al, ).…”

Section: Challeges Of a Regionalized Review Processmentioning

confidence: 99%

The evolution of the cancer formulary review in Canada: Can centralization improve the use of economic evaluation?

Wranik

Gambold

Hanson

et al. 2016

Int J Health Plann Mgmt

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SummaryPublic reimbursement of drugs is a costly proposition for health care systems. Decisions to add drugs to the public formulary are often guided by review processes and committees. The evolution of the formulary review process in Canada's publicly funded health system is characterized by increased centralization and systematization. In the past, the review of evidence and recommendation was conducted at the regional level, but was replaced with the pan‐Canadian Oncology Drug Review in 2011. We assess the extent to which centralization and systematization of the review process have responded to past challenges, focusing on the use of economic evaluation in the process. Past challenges with economic evaluation experienced by regionalized review committees were identified from literature and qualitative data collected in the province of Nova Scotia. We categorize these using a typology with a macro‐, meso, and micro‐level hierarchy, which provides a useful framework for understanding at which level change is required, and who has the authority to influence change. Using grounded theory methods, we identify approaches used by Nova Scotia past committee members to compensate for perceived shortcomings of the process. These include an undue reliance on other committee members, on the multidisciplinarity of the committee, and on past decisions. Using a policy analysis approach, we argue that centralization and systematization of the review process only partially address the shortcomings of the previous regionalized process. Lessons from Canada can inform policy discussions across all health systems, where similar challenges with the formulary review process have been identified. © 2016 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.

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“…So far, however, no reassessment report has become public; funding for bortezomib continues and its use in second line remains common. This is also valid for other reassessments of drugs included in the Dutch coverage with evidence development scheme; only a few reassessments have been finalized [18]. Interestingly, also the response-rebate scheme for bortezomib implemented in the UK was surrounded with issues.…”

Section: Discussionmentioning

confidence: 97%