Novel ways to fund cost-efficiency studies of expensive drugs: Efforts to maintain sustainable healthcare expenditure in the Netherlands.

Abstract

e18831 Background: The rising costs of new cancer drugs is a major burden for healthcare system. Healthcare providers and payers constantly look for solutions to reduce inefficient use of these drugs. Methods: These solutions may involve dose-rounding, dose-banding or vial-sharing to minimise the quantity of discarded pharmaceuticals. Alternative dosing strategies, such as tapering and/or increasing the dose-interval, shortening treatment duration, or boosting potency of the drugs may also be applied. Another approach is the development of predictive/monitoring biomarkers that can prevent mis-prescribing and overuse of therapies to patients who will not benefit from such a therapy. Provided that the therapeutic benefit is retained, a lower drug exposure evidently not only results in savings for the national healthcare budget but may also limit (off-target) toxicity, reduce hospitalisation and improve quality-of-life for patients. Results: Once compelling evidence of non-inferiority is available, the roll-out one of the strategies mentioned above is justified. Parties providing financial support for cost-efficiency initiatives are then often eager to support implementation and generate potential shared savings. However, when (additional) research is required to generate adequate evidence, fund raising and finding support can be quite challenging. In the Netherlands a dedicated national fund was recently established. Treatmeds, a foundation under Dutch law, is tasked to support cost-efficiency studies and to secure and manage (part of) the funding needed for those initiatives. Treatmeds is backed by Dutch healthcare insurers. Its governance provides for decisions based on the advice of an independent Scientific Advisory Board, an Intervention Board and a Financial Board. The Scientific Advisory Board aides with selecting studies for support on a pure scientific basis, the Intervention Board considers aspects as efficiency, the possibility of reimbursement under the Dutch compulsory healthcare insurance, the cost-benefit ratio of a study and the Financial Board ultimately decides on the financial aspects of supporting a study. Although Treatmeds only has just started its activities, it is expected that it can have a pivotal role in acceleration of efficiency tools in clinical practice. Conclusions: From our own experience we can state that a dedicated national fund supporting research on improved efficiency and quality of care can be of great value to accelerate study start-up and roll-out.