The new Dutch economic evaluation guideline

All parties in health care, from governments to hospitals, are bound to budgets. The use of economic evaluations helps these parties by determining how their budgets can be spend in the most optimal way. However, it is hard for some of these parties to make economic evaluations themselves or to determine the quality of existing economic evaluations or value statements. Guidelines exist to ensure that the level of an economic evaluation keeps up to certain standards. In the Netherlands, the last update of the main guideline was published in 2006. A new update of the guideline will be published this February by the National Health Care Institute. First, the guideline will be adjusted to comply with more recently updated add-ons modules such as the ‘cost manual’ and ‘the guideline for outcome research’. Secondly, the guideline had to reflect the fact that the field of economic evaluation in health care has expanded enormously since the last publication of the guideline (2006).

In this blog we focus on the expanded focus of the guideline. Up to recently, economic evaluations were almost exclusively applied to pharmaceuticals, which was contained in the guideline. Since then, a substantial expansion of economic evaluation into the area of medical devices has been seen.

Although the main guideline still focus on the evaluation of pharmaceuticals (in the guideline referred to as ‘standard evaluation’), the new guideline include a chapter of additional guideline in five non-pharma areas: prevention, diagnostics, medical devices, long term care and forensics. This reflects the relevance of the use of economic evaluations in other areas. Some examples of potential adaptations for the use of economic evaluations for medical devices could include:

Shorter horizon of the evaluation: the medical devices market is characterized by a shorter product life cycle. This will result in a shorter life-span for the device, which need to be reflected in the used horizon time.
Costs of the device: some devices can be used in more than only one population (think of a new CT scanner). These devices are called ‘collective devices’. If the value of a collective device is calculated, the effect on all populations need to be included.
Other types of outcomes: because some of the devices are not directed at improved clinical outcomes, but for example on the ease of use for the physician. These type of outcomes are called ‘intermediate outcomes’. Because a focus on intermediate outcomes is possible in medical devices, a cost-utility analysis is not always possible, and a cost effectiveness analysis can be used.

Economic evaluations provide the stakeholders with better tools to make better informed choices to spend their money wisely. Given the current context of restraint resources in health care and the aging population, the modern day medical device industry needs to be aware of the demands posed on them by the guideline and be prepared to present dependable economic evaluations.

Whether the new guideline (that provide a “golden standard” methodology also for areas other for Pharma such as medical devices) will lead to increased quality and quantity of economic evaluations remains to be seen. However, in the end that will only be useful if the decision makers on all levels (government, hospital or patient) will take the outcomes of high quality evaluations into account to determine their choices.

The guideline will be officially presented on the 16th of February 2016 in Amsterdam. A team of Panaxea will attend this presentation and report back about the key takeaways is on our website. Please contact us for more information or tell us about any specific questions you may have beforehand (info@panaxea.eu). We are dedicated to answer these and can relay questions to the guideline committee for their direct response.