Context
The Netherlands are facing a large increase in expenditure for medicines, of which cancer medicines make up a large share. In 2021, the Netherlands spent EUR 2.6 billion on medicines, 59% of which were for cancer treatments, urging for measures to contain costs. Stakeholders have agreed to review and evaluate the effectiveness of medicines in the Cross-sectoral Care Agreement (Integraal Zorgakkoord, IZA) (containing agreements for the organization and funding of care in the Netherlands) as new data become available.
Impetus
Following new studies into the effectiveness of cancer treatments, the Dutch Healthcare Institute has re-evaluated PARP inhibitors (a class of anticancer agents). The Dutch Healthcare Institute is tasked with providing advice to the government over the content of the basic benefits package. In practice, the Minister of Health follows this advice. Patients, healthcare professionals and health insurers have a say in this decision-making process. They can indicate which questions are important to consider in the assessments. In addition, they can comment on the outcome of assessments before their publication. Assessments are also reviewed by the Scientific Advisory Board of the Dutch Healthcare Institute, which consists of independent scientists, physicians, pharmacists, methodologists and health economists.
Main purpose of the reform
The main purpose of this revision is to contain costs and to slow expenditure increases on costly cancer medicines in order to keep the current health care system sustainable. Cancer medicines are among the most expensive medicines, and their share in the healthcare budget is rapidly increasing: Healthcare expenditure for cancer increased from EUR 0.8 billion in 2003 to EUR 3.7 billion in 2019. The growth in spending is primarily linked to the reimbursement of new treatments and early detection.
Content
Following recommendations of the Dutch Healthcare Institute, PARP inhibitors are no longer reimbursed for patients with those types of cancer that did not show improvement in either life expectancy or quality of life. For patient groups, in which effectiveness was proven, the medicines remain reimbursed.
Implementation steps taken and outcomes to date
The measure has been implemented as of June 2025. Patients no longer eligible for reimbursement but who started treatment before this decision came into force will be allowed to continue their treatment.
There are some critical voices questioning this decision. The Dutch Federation of Cancer Patients believes too much emphasis has been put on the average gain in survival for the whole group of patients and insufficiently takes quality of life into account. Similarly, the Dutch association of Medical Oncology supports re-assessments, but is critical of this one due to the methodology used by the studies on which the re-assessment is based, which, in their opinion, fall short from a qualitative perspective.