‘Stricter selection for new healthcare in basic insurance’

The National Health Care Institute will make stricter selections when advising on the inclusion of new treatments in the basic insurance. Moreover, it will look more emphatically as to which care that already falls under the basic insurance should be removed from it because it is not effective enough.

To make it clear that this stricter approach is serious, the Zorginstituut today presents three recommendations on expensive medicines and a position on expensive treatment. To the extent that the resources are eligible for reimbursement, strict conditions apply.

This new working method is intended to keep rising health care expenditure in check. These are increasing due to the aging population and the availability of new, often expensive, treatments and medicines. Inflation and wage increases of medical personnel also contribute to the increase in health care expenditure.

Kankermedicijnen

Two of the three recommendations to Minister Van Ark for Medical Care concern cancer drugs. If the Zorginstituut has its way, expensive combination therapy is not included in the insured package. There is not enough scientific evidence that the combination of these two drugs leads to overall survival gains.

Competition

The Dutch Association for Medical Oncology can live with the advice of the Zorginstituut. “Our profession does approve this combination therapy”, says NVMO chairman Haiko Bloemendal, who herself works at the Radboudumc in Nijmegen, “but we do not have any data on overall survival benefit yet.”

It is important for oncologists that a comparable combination medicine is included in the insured package.

“By putting this drug on hold, we don’t really remember anything to the patients. But you can imagine that if you allow it, there will be a competition between the two expensive drugs. That could turn out to be beneficial.”

Complicated game

Bloemendal is also satisfied with the advice to include another combination therapy for the treatment of hormone-sensitive breast cancer (HER2-positive breast cancer) in the basic insurance.

“This is a good treatment according to the current state of science and practice,” says Bloemendal. “That we then end up in a complicated game of price negotiations, so be it. We are not about the finances, but let’s face it: if the stuff cost a euro, it was easy.”

The Zorginstituut advises the minister to include the therapy in the basic insurance, but only after the average price of more than 64,000 euros per patient has been reduced. According to the Zorginstituut, its inclusion in the basic insurance results in more than 16 million euros in extra expenditure annually. Every year more than 400 women and a few men are eligible for treatment.

Nasal spray for depression

The Healthcare Institute also recommends including the nasal spray esketamine for patients suffering from severe depression and for whom other treatments do not help, in the basic package.

The drug must then be used – and the Zorginstituut follows the psychiatrists in this – as a possible fourth step in a treatment.

Moreover, the Zorginstituut wants the minister to start price negotiations for this drug – which costs more than 10,000 euros per patient per year. If the nasal spray is included in the basic insurance policy, this will lead to almost 16 million euros in extra expenditure annually.

Kunsthartklep

The insertion of an artificial heart valve through the groin is now reimbursed for patients who have a high risk of serious complications or death from open-heart surgery. This so-called TAVI operation was already insured for patients who cannot undergo open-heart surgery.

The procedure is not reimbursed for patients with a low or medium risk during open-heart surgery. It must first be shown whether TAVI artificial valves will continue to be sufficient in the long term. It must also become clear why more patients need a pacemaker after a TAVI procedure than after open-heart surgery in which an artificial valve is placed.

Because the TAVI operation is 15,000 euros more expensive than open-heart surgery, the associations of cardiologists and chest surgeons have drawn up a document together with the Zorginstituut to make it easier to determine which patients belong in the high-risk group.

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