Quantification of the potential impact of cost-effectiveness thresholds on dutch drug expenditures using retrospective analysis.

BACKGROUND Other than the UK, The Netherlands has no formal threshold for cost-per-QALY values defined yet. For example, a cutoff value at €20,000 per QALY is sometimes mentioned in various discussions, however it has no formal status at all. Yet, since 2005, all new innovative do have to go through a cost-effectiveness evaluation though, with the assessment being focused on the methodology rather than on the exact cost-per-QALY outcome. OBJECTIVE Our objective was to estimate the potential impacts on Dutch drug expenditures had a formal threshold been applied in recent years. METHODS We analyzed national Dutch prescription data for the period 2005-2007, with respect to the costs of specific newly introduced drugs with reported positive cost-effectiveness ratios. Various threshold values were investigated. RESULTS   In particular, our analysis suggests that modest, though annually increasing, reductions in Dutch drug expenditures could have been achieved in the recent period 2005-2007 if a threshold for cost-effectiveness at, for example, €20,000 per QALY been applied in The Netherlands. At thresholds of €0 and €20,000 estimated reductions in drug expenditures reflect approximately 0.25% of total Dutch drug expenditures and for thresholds of €50,000 and €80,000 this is only 0.01%. CONCLUSIONS Modest reductions in drug expenditures can be achieved if a formal threshold would be applied in The Netherlands. Potential reductions may be expected to increase in next years as expenditures for listed drugs increase further and new drugs become listed. Finally, we argue that for optimal and fair allocation of resources the in the health-care sector, application of a straightforward threshold is eminent and should not be postponed anymore.