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Public funding of pharmaceuticals in the Netherlands: investigating the effect of evidence, process and context on CVZ decision-making

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Abstract

The College Voor Zorgverzekeringen (CVZ) provides guidance to the Dutch healthcare system on funding and use of new pharmaceutical technologies. This study examined the impact of evidence, process and context factors on CVZ decisions in 2004–2009. A data set of CVZ decisions pertaining to pharmaceutical technologies was created, including 29 variables extracted from published information. A three-category outcome variable was used, defined as the decision to ‘recommend’, ‘restrict’ or ‘not recommend’ a technology. Technologies included in list 1A/1B or on the expensive drug list were considered recommended; those included in list 2 or for which patient co-payment is required were considered restricted; technologies not included on any reimbursement list were classified as ‘not recommended’. Using multinomial logistic regression, the relative contribution of explanatory variables on CVZ decisions was assessed. In all, 244 technology appraisals (256 technologies) were analysed, with 51 %, of technologies recommended, 33 % restricted and 16 % not recommended by CVZ for funding. The multinomial model showed significant associations (p ≤ 0.10) between CVZ outcome and several variables, including: (1) use of an active comparator and demonstration of statistical superiority of the primary endpoint in clinical trials, (2) pharmaceutical budget impact associated with introduction of the technology, (3) therapeutic indication and (4) prevalence of the target population. Results confirm the value of a comprehensive and multivariate approach to understanding CVZ decision-making.

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Notes

  1. This variable aims to capture whether the pharmaceutical product in question is linked to a disease area that is prioritised by the Ministry of Health, by examining government plans/health documents that highlight national healthcare system focus.

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Acknowledgments

The authors would like to thank Michael Drummond and Alistair McGuire for their valuable comments on the methods used and interpretation of analyses that were performed.

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Authors and Affiliations

  1. London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK

    Karin H. Cerri, Martin Knapp & Jose-Luis Fernandez

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  1. Karin H. Cerri
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  2. Martin Knapp
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  3. Jose-Luis Fernandez
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Correspondence to Karin H. Cerri.

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Cerri, K.H., Knapp, M. & Fernandez, JL. Public funding of pharmaceuticals in the Netherlands: investigating the effect of evidence, process and context on CVZ decision-making. Eur J Health Econ 15, 681–695 (2014). https://doi.org/10.1007/s10198-013-0514-z

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  • DOI: https://doi.org/10.1007/s10198-013-0514-z

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