Real-world cost-effectiveness: Potential & pitfalls in the context of conditional reimbursement

Abstract

The development of new and expensive health care technologies has increased pressure on national health care budgets as well as hospital budgets, leading to difficult questions about the affordability of new medicines. In order to strike an optimal balance between ensuring timely access to new drugs and having sufficient evidence of their relative benefits and risks, health care reimbursement policies have been increasingly rationalised and formalised over the past decades. The Netherlands is no exception in this context. Already since the early 1990s, the Dutch government has been developing policies linking reimbursement to evidence requirements aiming to reduce the growth rate of pharmaceutical costs without loss of medical quality. Over the years these evidence requirements as well the methods to demonstrate this evidence have greatly evolved. However, this progress has also led to greater complexity in reimbursement policy.