Dutch Health Minister Edith Schippers has announced that, starting with Novartis’ asthma drug Xolair (omalizumab), the national health insurance council will pay for some new drugs only if they produce a measurable effect on patients’ health.
If they do not, their costs will be reclaimed from the manufacturer, said the Minister, giving details of the new scheme, which the council – the College van Zorgerzekringen (CVZ) – has said will be the first time that the cost of a medicine will depend on the effects of the treatment.
The scheme is being introduced on the advice of the CVZ, which has reported that Xolair, costing 16,000 euros per patient per year, produces no effect in 30% of patients.
Speaking on BNR Radio, Ms Schippers said that the initiative is “certainly a good idea for new, expensive medicines that have not yet provided their worth” but would have “little advantage for medicines that have been on the market for a long time in various varieties and where prices are low,” reports DutchNews.nl.
The CVZ says that it already has an agreement in place with Novartis, clinicians and patients for the “no cure no pay” scheme, and that it expects the initiative to save up to 2 million euros a year.
The council had also recommended to Ms Schippers that expensive treatments for rare conditions such as Pompe and Fabry diseases should no longer be supplied under the Exceptional Medical Expenses Act (AWBZ), which insures the often long-term high costs of treatment, support, nursing and personal care. However, the Minister declined to accept this advice, saying that payments for expensive treatments for such conditions would continue.
Meantime, a new report by Ms Schippers’ predecessor as Dutch Health Minister, Ab Klink, estimates that the Netherlands could save as much as 8 billion euros a year, or almost 30% of the national health care budget, if medical professionals stopped giving patients “unnecessary and ineffective” treatments.
Doctors in the Netherlands are paid per treatment, and as a result they are too quick to advise patients to undergo complex, costly treatments without also discussing the consequences and any alternatives that might be available, he says.
Currently, the average Dutch family spends around 25% of its annual income on healthcare, and without major changes to government policy this percentage could double, says Mr Klink. The increase is not the result of the ageing population but is due to growth in the number of treatments, he adds.
Curbing what he sees as widespread over-treating would also prove a far less drastic method of dealing with the massive rise in healthcare costs than some other measures which are proposed, such as ending AWBZ coverage of expensive treatments or raising health insurance premiums.
A saving of 8 million euros a year represents an “ideal scenario” and, in practice, the savings could bit “a bit less, but at last 6 billion euros a year is achievable,” says Mr Klink, who is professor of healthcare, labour and political direction at the Vrije University in Amsterdam, and also runs the healthcare practice of global management consultancy firm Booz & Co in the Netherlands.