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

Cerri, Karin H., Knapp, Martin and Fernandez, Jose-Luis (2013) Public funding of pharmaceuticals in the Netherlands: investigating the effect of evidence, process and context on CVZ decision-making. The European Journal of Health Economics, online . ISSN 1618-7598 (In Press)

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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.

Item Type: Article
Official URL: http://link.springer.com/journal/10198
Additional Information: © 2013 Springer-Verlag Berlin Heidelberg
Library of Congress subject classification: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RS Pharmacy and materia medica
Journal of Economic Literature Classification System: I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy; Regulation; Public Health
Sets: Departments > Social Policy
Research centres and groups > Personal Social Services Research Unit (PSSRU)
Rights: http://www.lse.ac.uk/library/usingTheLibrary/academicSupport/OA/depositYourResearch.aspx
Date Deposited: 30 Jul 2013 11:31
URL: http://eprints.lse.ac.uk/51239/

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